36C25918R0596-0001005.docx

NON-DISCLOSURE AGREEMENT AND STATEMENT OF FINANCIAL INTEREST

RFP#: __________________________

Description: _____________________

I understand that in connection with my participation in request for proposals ___________________, for _______________services for the _______________________VAMC. I may be granted access to information relating to any aspect of that acquisition. I hereby agree that I will not discuss with or reveal to any representative of any governmental entity, business organization, other entity, or any individual person (except persons specifically authorized by the Contracting Officer or Source Selection Authority, either within or outside the U.S. Government, any aspect of RFP _____________). The information includes, but is not limited to, information contained (or to be contained) in any acquisition documentation created by the Service Area Office (SAO), trade secrets and other proprietary information (18 U.S.C. §§ 1832, 1905), the number and identity of VA personnel involved, and the schedule of key technical and acquisition events in the acquisition process. Except as specifically authorized by the Contracting Officer, release of such information is not authorized. I agree that this obligation shall continue both during the period of my current participation and thereafter.

I recognize that a significant factor in the successful and proper completion of RFP _____________________ is the strict confidentiality observed by all participants in the various evaluations, reviews, and discussion groups concerning all of the activities and procedures involved in acquisition development, and that failure to comply with these requirements may compromise the award decision. I acknowledge that the unauthorized release of acquisition information may result in the termination of my participation in this acquisition. Furthermore, I am aware that the unauthorized release of such information may subject me to criminal and civil penalties and adverse personnel actions.

In the event that I release any information described above or become aware that such information has been released by someone else, I agree to so advise the Contracting Officer. When so advising the Contracting Officer, I will provide the Contracting Officer with the following information: (1) the business organization or other entity, or individual person, to whom the information in question was divulged, (2) the identity of the person that disclosed the information, and (3) the content of the information.

I further affirm that I will (1) disclose to the Contracting Officer and the Office of Counsel whether I or any member of my immediate family* have any holdings or interest whatsoever in any Offeror, their subcontractors, joint venture partners, or team members, and (2) if I or a member of my immediate family* acquire holdings or interest in any Offeror, their subcontractors, joint venture partners, or team members, notify the Contracting Officer and will not participate in any aspect of the source selection for acquisition stated herein unless authorized to do so by the Contracting Officer and the Office of Counsel.

* The interest of a spouse, minor child, or other member of the employee’s immediate household is reported in the same manner as an interest of the employee.