3._Conflict_of_Interest.pdf

CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT

As an authorized representative or corporate officer of the company name below, I have the authority to bind the company contractually, and I agree that all persons employed by this company will adhere to the following policy:

All information belonging to the Office of Planning and Research (OPR) or its affiliated agencies is considered sensitive and confidential and cannot be disclosed to any person or entity that is not directly approved to participate in the work required to execute this Agreement.

I certify that I has no personal or financial interest and no present or past employment or activity which would be incompatible with my participation in any activity related to the planning or procurement processes for the project or procurement. I agree that no gift, benefit, gratuity or consideration will be accepted and there is no personal or financial interest, or association initiated on a project or procurement.

I certify that I will keep all project information including (but not limited to) information concerning the planning, processes, development or procedures of the project, and all communication with OPR or its affiliates related to any procurement process, confidential and secure. I will not copy, give or otherwise disclose such information to any other person unless OPR has on file a Conflict of Interest and Confidentiality Statement signed by the other person(s), and the disclosure is authorized and necessary for the project. I understand that the information to be kept confidential includes, but is not limited to, specifications, administrative requirements, terms and conditions, concepts and discussions, as well as written and electronic materials. I further understand that if I leave this project before it ends, I must still keep all project information confidential. I agree to follow any instructions provided by the project relating to the confidentiality of project information.

I fully understand that any unauthorized disclosure I make may be basis for civil and/or criminal penalties. I agree to advise the Contract Manager immediately in the event of an unauthorized disclosure, inappropriate access, misuse, theft or loss of data.

I warrant that if my company is awarded the Contract, it will not enter into any agreements or discussions with a third party concerning such materials prior to receiving written confirmation from OPR that such third party has an agreement with the State similar in nature to this one. All materials provided for this project, except where explicitly stated will be promptly returned or destroyed, as instructed by an authorized OPR representative. If the materials are destroyed and not returned, a letter attesting to their complete destruction, which documents the destruction procedures, must be sent to the Contract Manager before payment can be made for services rendered. In addition, all copies or derivations, including any working or archival backups of the information, will be physically and/or electronically destroyed within five (5) calendar days immediately following either the end of the Contract period or the final payment, as determined by the Contract Manager.

CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT

All personnel assigned to this project shall be provided a Conflict of Interest and Confidentiality Statement and will be expected to sign and return it to the Contract Manager before beginning work on this project.

Representative Name / Title:

Company Name:

Address:

Telephone / Fax Number:

Email Address:

Signature/Date: