AIDEA25-009 RFP - Attachment 3 - Former Employee Certificate.pdf
PDF 213 KB Posted
- Attached to
- Ketchikan Shipyard Material Assessment _RFP
- Solicitation number
- AIDEA25-009
- Issued by
- Ketchikan Gateway Borough, Alaska
About this file
This is a Former Employee's Certification of Eligibility form from the Alaska Industrial Development and Export Authority (AIDEA) for RFP #AIDEA25-009, titled "Ketchikan Shipyard Material Assessment." The document is a certification form required for former State of Alaska employees who left state service within the last two years and wish to work on this project. The form requires the former employee to certify that their proposed work will not involve matters they participated in during their state service through official actions.
The form requires notarization and includes specific declarations regarding the non-disclosure of confidential information acquired during state service. The document includes spaces for the former employee to fill in their previous job title, state agency, current employer, and project details. If a notary is unavailable, the form provides an alternative statement to be included. No specific pricing terms, set-asides, or funding information is included in this document.
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Other files
| File | Type | Posted |
|---|---|---|
| AIDEA25-009 RFP - Attachment 4 - Debarment Solicitation.pdf | ||
| RFP #2025-2000-0184.pdf | ||
| AIDEA25-009 RFP - Full Packet.pdf.crdownload | CRDOWNLOAD file | |
| AIDEA25-009 RFP - Attachment 5 - Sample PSA.pdf.crdownload | CRDOWNLOAD file | |
| AIDEA25-009 RFP - Attachment 2 - Insurance Appendix-b2.pdf | ||
| AIDEA25-009 RFP.pdf | ||
| AIDEA25-009 RFP - Attachment 1 - Cost Proposal.xlsx | XLSX spreadsheet | |
| AIDEA25-009 RFP - Attachment 5 - Sample PSA.pdf | ||
| AIDEA25-009 RFP - Full Packet.pdf |
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Text version
ALASKA INDUSTRIAL DEVELOPMENT AND EXPORT AUTHORITY
Former Employee’s Certification of Eligibility Under the Alaska Executive Branch Ethics Act
(AS 39.52.140, AS 39.52.180)
Project Title: KETCHIKAN SHIPYARD MATERIAL ASSESSMENT
RFP # AIDEA25-009
I am a former employee of the State of Alaska and left state service within the last two years. My last position with the state was [job title] with the [name of state agency and administrative unit]. I propose to work on [describe state contract or other matter] on behalf of [name of current employer]. This work will not involve any matter (a) that was under consideration by the state administrative unit that I served, and (b) in which I participated personally and substantially during my state service through the exercise of official action (“official action” means a recommendation, decision, approval, disapproval, vote, or other similar action or inaction). I am therefore eligible to participate in this [contract or matter] under the Alaska Executive Branch Ethics Act. I also understand that as a former public officer I may not disclose or use information acquired in the course of my official duties that could in any way result in a benefit to me or my family, if the information has not been disseminated to the public, or that is confidential by law, without appropriate authorization.
I certify under penalty of perjury that the foregoing is true.
Dated: ________________________, 20__, at __________, Alaska.
[name of former state employee]
STATE OF ALASKA )
) ss.
_______ JUDICIAL DISTRICT )
On this ______ day of ____________, 20__, [name of former state employee], whom I know to be the individual described in and who executed this certification, personally appeared before me and acknowledged that [s]he signed the certification as [her or his] free and voluntary act.
IN WITNESS WHEREOF, I have placed my signature and affixed my official seal.
Notary Public in and for Alaska My commission expires: ___________
If no notary or other official (judge, magistrate, U.S. postmaster or municipal clerk) is available, omit the notary certificate and include the following statement in the text: A notary or other official empowered to administer oaths is unavailable.
Former Employee’s Certification of Eligibility
File details come from the government source that posted it. Updated .