Attachment 2 - Conflict of Interest Statement.pdf
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- Attached to
- 27 SOCES - Patch Trailer
- Solicitation number
- FA485526Q0032
About this file
This is a Conflict of Interest Statement template required for federal contract opportunities under FAR subpart 3.6.
The document establishes certification requirements for contractors and company owners to disclose their employment status with the federal government. Signatories must certify either that neither they nor company owners/controllers are federal employees, or conversely, that they or a company owner/controller is a federal employee. The statement defines "Employee" according to 5 U.S.C. 2105 and prohibits contract awards to government employees or organizations substantially owned or controlled by them. The document includes provisions requiring contractors to promptly disclose any actual or potential conflicts of interest in writing to the Contracting Officer and cooperate with mitigation measures. Contractors must commit to compliance with all applicable federal ethics, procurement integrity, and conflict of interest regulations, including FAR subparts 3.6 and 9.5, plus any agency-specific requirements. The form requires signature by an authorized company representative who can legally bind the organization, along with name, date, organization name, phone number, and email address. The signatory declares under penalty of perjury that all statements are true and correct to the best of their knowledge.
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Text version
ATTACHMENT 4 – CONFLICT OF INTEREST STATEMENT
Pursuant to Federal Acquisition Regulation (FAR) subpart 3.6 – Contracts with Government Employees or Organizations Owned or Controlled by Them, the Government is prohibited from awarding a contract to a Government employee or other organization owned or substantially owned or controlled by one of more Government employees.
Employee means, an employee as defined in 5 U.S.C. 2105.
CONFLICT OF INTEREST STATEMENT
☐ I, the undersigned, certify that neither I nor any member of the company who owns or substantially owns or controls the company, to the best of my knowledge, is not an employee of the Government.
☐ I, the undersigned, certify that I or a member of the company who owns or substantially owns or controls the company, is an employee of the Government.
Disclosure of Potential Conflicts
If any actual or potential conflict of interest arises during the course of this engagement with the federal government, we will promptly disclose it in writing to the Contracting Officer and cooperate fully in any mitigation measures deemed necessary.
Commitment to Compliance
We understand and agree to comply with all applicable federal ethics, procurement integrity, and conflict of interest regulations, including but not limited to FAR subpart 3.6 and FAR subpart 9.5 and any agency-specific requirements.
I, the undersigned, certify that I am an individual who has the authority to sign for and legally bind the Company and hereby declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge.
Name: _______________________________________________ Date: _____________
Organization: __________________________________________________________________
Phone: __________________ Email: __________________________________________
Signature: _______________________________
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