AttachH_DiscExmpt.pdf

PEBB Medical & Pharmacy Benefits RFP OregonBuys Bid No. S-44300-00014758 Attachment H

ATTACHMENT H — DISCLOSURE EXEMPTION AFFIDAVIT

____________________ (Affiant), being first duly sworn under oath, and representing [insert Proposer Name] (hereafter “Proposer”), hereby deposes and swears or affirms under penalty of perjury that:

1. I am authorized by the Proposer, I have knowledge of the Request for Proposals referenced herein, and I have full authority from the Proposer to submit this affidavit and accept the responsibilities stated herein.

2. I am aware that the Proposer has submitted a proposal, dated on or about November 14, 2025 (the “Proposal”), to the State of Oregon (State) in response to Request for Proposals under OregonBuys Bid No. S-44300-00014758 for Medical and Pharmacy Benefits services, and I am familiar with the contents of the RFP and Proposal.

3. I have read and am familiar with the provisions of Oregon’s Public Records Law, Oregon Revised Statutes (“ORS”) 192.311 through 192.478, and the Uniform Trade Secrets Act as adopted by the State of Oregon, which is set forth in ORS 646.461 through ORS 646.475. I understand that the Proposal is a public record held by a public body and is subject to disclosure under the Oregon Public Records Law unless specifically exempt from disclosure under that law.

4. I have reviewed the information contained in the Proposal. The Proposer believes it has accurately and completely indicated the portions of its Proposal and related submissions that are exempt from disclosure under Oregon’s Public Records Law (Exempt Information) and has provided corresponding legal bases and redacted responses as instructed in the Proposal Submission Website. It is my opinion that the Exempt Information is exempt from disclosure under Oregon’s Public Records Law or constitutes “Trade Secrets” under either the Oregon Public Records Law or the Uniform Trade Secrets Act as adopted in Oregon because that information is either:

A. A formula, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information that:

i. is not patented,

ii. is known only to certain individuals within the Proposer’s organization and that is used in a business the Proposer conducts,

iii. has actual or potential commercial value, and

iv. gives its user an opportunity to obtain a business advantage over competitors who do not know or use it.

or

B. Information, including a drawing, cost data, customer list, formula, pattern, compilation, program, device, method, technique or process that:

i. Derives independent economic value, actual or potential, from not being generally known to the public or to other persons who can obtain economic value from its disclosure or use; and

PEBB Medical & Pharmacy Benefits RFP OregonBuys Bid No. S-44300-00014758 Attachment H

ii. Is the subject of efforts by the Proposer that are reasonable under the circumstances to maintain its secrecy.

5. I understand that disclosure of the information claimed as Exempt Information through the RFP’s Proposal Submission Website may depend on official or judicial determinations made in accordance with the Public Records Law.

Affiant’s Signature

State of ___________)

) ss:

County of ________)

Signed and sworn to before me on ___________ (date) by ______________________ (Affiant’s name).

Notary Public for the State of _________________

My Commission Expires: _______