6. Exhibit F - Non-Conflict of Interest.pdf
PDF 120 KB Posted
- Attached to
- Administrative Hearing Officer - Parole Board
- Solicitation number
- DQ1 CAAA 2027000125 1
- Issued by
- Garfield County, Colorado
About this file
This is a Non-Conflict of Interest declaration form required by the Colorado Department of Corrections for the Administrative Hearing Officer - Parole Board position. The document mandates that all bidders complete and return the form as part of their bid submission. Signatories must certify compliance with Colorado Revised Statutes 18-8-302, 18-8-306, 18-8-301, and 18-8-308, as well as the State of Colorado State Controller Policy on Procurement Conflicts of Interest. The form requires acknowledgment that no actual, potential, perceived, or apparent conflicts of interest exist and that the signatory understands the authority of the Procurement Official to remove participants as deemed appropriate.
The declaration further obligates signatories to maintain confidentiality of any State information or records accessed during the procurement process, with the CDOC Procurement Official designated as the records custodian. Participants commit to immediate notification of the Procurement Agent if any situation arises that could alter their representations or create an appearance of conflict or impropriety. The form applies to employees of private employers and independent contractors under contract with the State of Colorado and requires the printed name, signature of an authorized signer, and company name or dba information to be completed before submission.
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Text version
EXHIBIT F
COLORADO DEPARTMENT OF CORRECTIONS
STATE OF COLORADO
NON-CONFLICT OF INTEREST
(You must complete and return this document with Bid)
I have read Colorado Revised Statutes, 18-8-302, 18-8-306, 18-8-301, and 18-8-308, as amended, and no violations of such provisions are present.
I have read the State of Colorado State Controller Policy – Procurement conflicts of Interest
Policy (https://www.colorado.gov/pacific/osc/procurement-conflicts-interest-policy) and affirm I have no actual, potential, perceived or apparent conflicts of interest.
I understand the Procurement Official is empowered to remove me in any way he/she deems appropriate. I can request to be removed at any time, which can be granted or denied by the
Procurement Official.
I understand that as a participant in this process I may have access to State information and/or records. The CDOC Procurement Official is the custodian of records. Information shall not be distributed, sold or shared with any third party or used in any way except as expressly authorized.
I do not have any personal or beneficial interest in the service or property described in the attached Colorado Revised Statutes.
If I should become aware of any situation, which might arise, that could alter any of the representations above or that might otherwise create the appearance of a conflict or other impropriety, I will notify the Procurement Agent immediately.
I am an employee of a private employer or an independent contractor under contract with the
State of Colorado. I understand that I am receiving such information in such capacity.
Print Name of authorized signer and Signature of authorized signer
Print Company Name/dba
File details come from the government source that posted it. Updated .