Attachment 4 - Conflict of Interest Statement.pdf
PDF 186 KB Posted
- Attached to
- TOC in a BOX - Tactical Transit Case
- Solicitation number
- FA485526Q0050
About this file
This document is a Conflict of Interest Statement template required for federal contract proposals under the Revolutionary FAR Overhaul (RFO) subpart 3.6.
The statement establishes that the Government is prohibited from awarding contracts to Government employees or organizations owned, substantially owned, or controlled by one or more Government employees, with "employee" defined according to 5 U.S.C. 2105. Respondents must certify under one of two checkbox options: either that neither they nor any company owner or controller is a Government employee, or that they or a company owner/controller is a Government employee. The document requires signatories to commit to prompt written disclosure of any actual or potential conflicts of interest to the Contracting Officer and to comply with all applicable federal ethics, procurement integrity, and conflict of interest regulations, including RFO subparts 3.6 and 9.5, and any agency-specific requirements. The signatory must certify under penalty of perjury that they have authority to legally bind the company and that all statements are true and correct. Required completion fields include name, date, organization, phone, email, and signature. This is a template form with no specific contract award information, response deadlines, or pricing terms.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 5 - Provisions and Clauses.pdf | ||
| Combined Synopsis_Solicitation - TOC in a BOX.docx | DOCX document | |
| Attachment 2 - Pricing Worksheet - Template for Commodities and One Time Services.xlsx | XLSX spreadsheet | |
| Attachment 3 - Offeror Information and Certification.pdf |
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Text version
ATTACHMENT 4 – CONFLICT OF INTEREST STATEMENT
Pursuant to the Revolutionary FAR Overhaul (RFO) 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 RFO subpart 3.6 and RFO 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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