affidavit-of-no-change-to-financial-disclosures-and-conflicts-of-interest-v.23.1.pdf

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Affidavit of No Change to Financial Disclosures and Conflicts of Interest State of Illinois Chief Procurement Office General Services Affidavit of No Change to Financial Disclosures and Conflicts of Interest v.23.1 Page of 6.5.0.20190320.2.935878.932721 If a bid or offer is received from a responsive bidder, offeror, vendor, contractor, or subcontractor with an annual value of more than $100,000 and the bidder, offeror, vendor, contractor, or subcontractor has an active contract with that same entity and already has submitted their financial disclosures and potential conflicts of interest within the last 12 months, the bidder, offeror, vendor, contractor, or subcontractor may submit a signed affidavit attesting that the original submission of its financial disclosures and potential conflicts of interests has not been altered or changed. The form and content of the affidavit shall be prescribed by the applicable chief procurement officer. 30 ILCS 500/50-35 (j).

This form may only be used when two conditions are satisfied. First, Vendor has an active contract with the State agency to which the affidavit is being submitted. Second, the affidavit is being submitted and received within 12 months of when the State agency accepted the original submission of Financial Disclosures and Conflicts of Interest (FD & COI).

Section I. Procurement or Contract Information for which the Affidavit is being submitted Section II. Active Contract Information Please attach a copy of the fully executed contract signature page.

Section III. 12-Month Calculation of Original Submission of FD & COI To determine if the affidavit is being submitted and received within 12 months of the original submission of FD & COI, Vendor needs to identify when the 12-month clock started and when the affidavit is officially received by the State agency.

Start of 12-Month Clock The 12-month clock starts on one of two dates depending on how Vendor's active contract was procured. If Vendor's active contract was procured using an invitation for Bid (IFB) or Request for Proposal (RFP), then the clock starts on the date of the Notice of Award. If Vendor's active contract was procured as a sole source, emergency, or small purchase, or was a contract renewal in which a full set of FD & COI was provided (a "Certification of No Change for Contract Renewal" was not used) then the clock starts on the date of the State agency's contract execution.

Affidavit Received by State The affidavit is officially received by the State agency on the date determined by the reason for which the affidavit is being submitted.

If providing the affidavit with an IFB or RFP, the affidavit is officially received on the Bid/Offer Due Date.

If providing the affidavit with a contract procured as a sole source or emergency, or with a contract renewal, the affidavit is officially received on the date that the State executes the contract.

Section IV. Certification of No Change This disclosure is signed by an authorized officer or employee on behalf of the Vendor identified in Section I. The undersigned certifies that the statements set forth in this document are true and accurate, and made under the penalty of perjury if the original financial disclosures and conflicts of interest were submitted under the penalty of perjury.