Attachment 4 - Conflict of Interest Statement.pdf
PDF 186 KB Posted
- Attached to
- B4625 TRANE CHILLER REPLACEMENT
- Solicitation number
- FA485526Q0011
About this file
This is a Conflict of Interest Statement template required for federal contract solicitations under the Revolutionary FAR Overhaul (RFO) subpart 3.6. The document establishes compliance requirements prohibiting the Government from awarding contracts to Government employees or organizations owned, substantially owned, or controlled by Government employees as defined in 5 U.S.C. 2105.
The statement requires the signatory to certify under penalty of perjury whether they or any company owner/controller is a Government employee, with two checkbox options for affirmative or negative disclosure. The template obligates respondents to promptly disclose in writing 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 agency-specific requirements. The document must be completed and signed by an individual with authority to legally bind the company, and includes required fields for name, date, organization, phone, email, and signature. This is a template form with no specific products, services, response dates, or award information.
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Other files
| File | Type | Posted |
|---|---|---|
| Combined Synopsis Solicitation.pdf | ||
| Attachment 6 - Brand Name Justification.pdf | ||
| Attachment 1 - Salient Characteristics.pdf | ||
| Attachment 2 - Pricing Worksheet.xlsx | XLSX spreadsheet | |
| Attachment 3 - Offeror Information and Certification.pdf | ||
| Attachment 5 - Provisons and Clauses.pdf | ||
| Combined Synopsis Solicitation.docx | DOCX document |
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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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