Attachment 3 - Conflict of Interest Certification for Advisory and Assistance Services.docx

Attachment 3

RFP 2031JW21R00010

National Bank Examination Services

CONFLICT OF INTEREST CERTIFICATION FOR

ADVISORY AND ASSISTANCE SERVICES

Agency: The Office of the Comptroller of the Currency

Services to be rendered through procurement:

Offeror’s Name: ___________________________________________________

Address: ___________________________________________________

Telephone Number: ______________________________

Federal Taxpayer Identification or Social Security #: __________________________

I, ____________________________ (name of certifier), am the officer or employee responsible for the preparation of the offer in response to the above cited solicitation number and hereby certify that I have made inquiry and that, to the best of my knowledge and belief, (a) no actual or potential conflict of interest or unfair competitive advantage exists with respect to the advisory and assistance services to be provided in connection with this procurement, or (b) that any actual or potential conflict of interest or unfair competitive advantage that does or may exist with respect to the procurement in question has been communicated in writing to the Contracting Officer or her representative.

I further certify that if, in the 12 months preceding the date of this certification, services were rendered to the government or any other client (Including a foreign government or person) respecting the same subject matter as this solicitation, or directly relating to such subject matter, the name, address, telephone number of the client(s), a description of the services rendered to the client(s), and the name of a responsible officer or employee of the offeror who is knowledgeable about the services rendered to each client have been communicated in writing to the Contracting Officer or her representative. Additionally, the agency and contract number under which the services were rendered, if applicable, have been provided to the Contracting Officer or her representative.

Name (Printed): _______________________________________________________

Address: _______________________________________________________

Telephone Number: ____________________________________