J_Attachment 4_COI Cert_Contractor to Sign_1.docx
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- Attached to
- Minerals Revenue Management Support System Federal contract opportunity
- Solicitation number
- 140D0420R0005
About this file
This draft request for proposal concerns a contract to provide minerals revenue management support system services to the Department of the Interior's Office of Natural Resource Revenue. The government seeks to modernize its systems used for royalty and revenue collection from natural resources extracted from public lands. Potential offerors are invited to review the draft RFP documents and submit any questions by February 23rd. Offerors should not submit proposals in response to this draft as this opportunity is still in the market research phase. The final RFP will be issued after the question period concludes. Interested parties can access the draft documents and schedule reading room sessions by contacting the identified contracting officials.
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Text version
● Page January 12, 2012 Minerals Revenue Management Support System (MRMSS) Office of Natural Resource Revenue (ONRR) Section J – Attachment XX
CERTIFICATE FOR CONFLICT OF INTEREST
Contract Number:
PWS Title:
| TO: | __________________________ |
| Print Name / Contracting Officer |
| THROUGH: | __________________________________ | |
| Print Name / Company Project Manager |
| FROM: | _______________________________ |
| Print Name / Contractor Employee |
I certify that I am not aware of any matter that might limit my ability to work on contracts and related actions in an objective and unbiased manner or which might place me in a position of a conflict, actual, potential, or apparent, between my responsibilities as a support contractor.
In making this certification, I have considered all my stocks, bonds, and other financial interests, and employment arrangements (past, present, or under consideration) and , to the extent known by me, all the financial interests and employment arrangements of my spouse, my minor children, and other members of my immediate household.
If, after the date of this certification, any person, firm, or other organization with which, to my knowledge, I (including my spouse, minor children, and other members of my immediate household) have a financial interest, or with which I have (or had) an employment arrangement, becomes involved in the acquisition I am responsible for, I will notify the Contracting Officer of this apparent conflict of interest. In such case, until advised to the contrary, I will not participate further in any way (by rendering advice and making recommendations on the applicable contract and/or related action.
| _____________________________ | ________________ | |
| (Contractor Employee Signature) | Date |
Section J – Attachment XX
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