6-03 - Conflict of Interest Questionnaire.pdf

This document is a Conflict of Interest Questionnaire form (Appendix D) related to a Texas state and local contract opportunity for Ancillary Insurance Benefits. The procurement seeks to award contracts for Life, Disability, Employee Assistance Program (EAP), Health Savings Account (HSA)/Flexible Spending Accounts (FSA)/Health Reimbursement Arrangement (HRA), COBRA administration, and voluntary worksite products. The form is designed for firms that have chosen not to submit a proposal for this procurement and provides instructions for submitting a "No Intent to Submit" declaration to the appropriate agency contact.

The document serves as a mechanism to formally document the decision of potential bidders who do not intend to participate in this procurement opportunity. By completing and submitting this form, firms establish a clear record of their non-participation, which may be relevant for conflict of interest and competitive fairness purposes. This form should be submitted in accordance with the submission procedures outlined in the procurement solicitation documents.