6. Exhibit F - Non-Conflict of Interest.pdf
PDF 116 KB Posted
- Solicitation number
- DQ1 CAAA 2027000071 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 Boiler Chemicals & Treatment Services contract opportunity in Colorado. The form serves as a compliance document that bidders must complete and return with their bid submissions. By signing the declaration, the authorized representative affirms that they have reviewed the relevant Colorado Revised Statutes (18-8-302, 18-8-306, 18-8-301, and 18-8-308) and the State of Colorado State Controller Policy on Procurement Conflicts of Interest, and certifies that no actual, potential, perceived, or apparent conflicts of interest exist. The signatory acknowledges their understanding of the Procurement Official's authority to remove them from the process if necessary and agrees to notify the Procurement Agent immediately if any situation arises that could alter their representations or create the appearance of conflict or impropriety.
The declaration additionally establishes that the signer has access to State information and records as a participant in the procurement process, which must not be distributed, sold, shared with third parties, or used except as expressly authorized by the CDOC Procurement Official, who serves as the custodian of records. The form confirms that the signer is either an employee of a private employer or an independent contractor under contract with the State of Colorado and is receiving information in such capacity. The completed form requires the printed name and signature of an authorized signer as well as the company name or doing business as (dba) designation.
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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
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