Attachment 4 - Conflict of Interest Statement.pdf
PDF 186 KB Posted
- Attached to
- Protestant Music Director
- Solicitation number
- FA485526Q0077
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 certification 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. Signatories must certify either that neither they nor company owners/controllers are Government employees, or conversely, disclose if they or company principals hold Government employment status. The statement requires respondents 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 agency-specific requirements. The authorized company representative must sign under penalty of perjury, providing name, organization, date, phone number, email, and signature. This is a template document without specific solicitation details, response dates, or contractual terms.
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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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