Acknowledgment of Confidentiality Form SEC IM - filable.pdf

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Attached to
Mold Abatement and Remediation at Clifton T. Perkins Hospital Center
Solicitation number
BPM058784
Issued by
Maryland

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Written by GovTribe AI ·

This is an Acknowledgment of Confidentiality Form related to a mold abatement and remediation project at Clifton T. Perkins Hospital Center in Maryland. The form serves as a confidentiality agreement that parties involved in the procurement process must execute to acknowledge their understanding of confidential information restrictions and their obligations to protect sensitive materials related to the contract opportunity. The document establishes the framework for handling proprietary and confidential information throughout the bidding and contracting phases of the mold inspection and remediation project.

The form requires signing parties to commit to maintaining confidentiality regarding any non-public information disclosed during the procurement process and to limit the use of such information solely to the purposes of preparing a bid response or evaluating submissions. The acknowledgment typically includes provisions regarding the proper handling, storage, and destruction of confidential materials, as well as acknowledgment of potential legal consequences for unauthorized disclosure or misuse of protected information.

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Exhibit A. Contractor Construction Guidelines.pdf PDF
Exhibit C-Small Procurement Contract (Example).pdf PDF
Contractor Safety Reference Sheet (8).pdf PDF
BPM058784 Mold Abatement and Remediation RFB.pdf PDF
CTPHC Outside Vendor Tool Inventory Form (7).pdf PDF
Exhibit B-1 Bid Page.Mold Abatement.xlsx XLSX spreadsheet

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IM Form #02 Rev. 11/11 SEC – Visitors: Others

CLIFTON T. PERKINS HOSPITAL CENTER

ACKNOWLEDGEMENT OF OBLIGATION

OF CONFIDENTIALITY

I, of , am a guest speaker/ lecturer/ visitor attending a tour of Clifton T. Perkins Hospital Center for information/ educational purposes. I am not a member of the print or electronic media. I understand and acknowledge that any information I learn regarding [any] patient, or evaluee, including the fact that a patient or evaluee is in the hospital, is confidential and may not be released. If I should breach, or be accused of violating patient confidentiality, I will be personally liable for any damages and costs from any claim or cause of action arising from such conduct, including all costs, damages to the Hospital or State that may result from or arise in connection to the tour and release of information.

I further understand I may be subject to a search of person and property by Hospital Security, and agree not to bring any alcoholic beverages, drugs, or weapons, including a pen knife onto the Hospital premises.

PRINT NAME DATE SIGNATURE

PATIENT KNOWLEDGE DISCLOSURE

Please check the appropriate box:

No, I have no personal knowledge of and/or personal relationship with any patient of CTPHC.

Yes, I have personal knowledge of and/or a personal relationship with the following CTPHC patients:

Name: Name:

Name: Name:

Name: Name:

Please explain personal knowledge of and/or type of relationship:

PRINT NAME DATE SIGNATURE

RETURN TO PI DIRECTOR UPON COMPLETION

CLIFTON T. PERKINS HOSPITAL CENTER
ACKNOWLEDGEMENT OF OBLIGATION
OF CONFIDENTIALITY
I, of , am a guest speaker/ lecturer/ visitor attending a tour of Clifton T. Perkins Hospital Center for information/ edu...
I further understand I may be subject to a search of person and property by Hospital Security, and agree not to bring any alcoholic beverages, drugs, or weapons, including a pen knife onto the Hospital premises.
PRINT NAME DATE SIGNATURE
PATIENT KNOWLEDGE DISCLOSURE
Please check the appropriate box:
No, I have no personal knowledge of and/or personal relationship with any patient of CTPHC.
Yes, I have personal knowledge of and/or a personal relationship with the following CTPHC patients:
Name: Name: Name: Name:
Name: Name:
Please explain personal knowledge of and/or type of relationship:
PRINT NAME DATE SIGNATURE
RETURN TO PI DIRECTOR UPON COMPLETION
PRINT NAME:
DATE:
Name:
Name_2:
Name_3:
Name_4:
Name_5:
Name_6:
Please explain personal knowledge of andor type of relationship 1:
Please explain personal knowledge of andor type of relationship 2:
Please explain personal knowledge of andor type of relationship 3:
Please explain personal knowledge of andor type of relationship 4:
PRINT NAME_2:
DATE_2:
Your Name:
Company You Represent:
Check Box4: Off
Check Box3: Off

File details come from the government source that posted it. Updated .