Attachment 4 - Conflict of Interest Statement.pdf
PDF 186 KB Posted
- Attached to
- 27 SOCONS JRC VTC
- Solicitation number
- FA485526Q0013
About this file
This is a Conflict of Interest Statement form required for federal contract bidders under the Revolutionary FAR Overhaul (RFO) subpart 3.6. The form certifies whether the signatory or company ownership has any affiliation with U.S. Government employees, as the Government is prohibited from awarding contracts to Government employees or organizations owned or substantially controlled by them. The form provides two certification options: one stating that neither the signatory nor company owners are Government employees, and an alternative for those who are Government employees. Signatories must declare under penalty of perjury that their certification is true and correct.
The form also requires commitment to compliance 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. Signatories must agree to promptly disclose any actual or potential conflicts of interest in writing to the Contracting Officer and cooperate with any required mitigation measures. The form requires the authorized company representative to provide their name, date, organization, phone number, email, and signature. This is a template document used as an attachment to federal solicitations.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 2 - Pricing Worksheet.xlsx | XLSX spreadsheet | |
| Attachment 6 - Q and A.pdf | ||
| Attachment 1 - PWS - 27 SOCONS VTC 1.pdf | ||
| Attachment 3 - Offeror Information and Certification.pdf | ||
| Combined Synopsis_Solicitation.pdf | ||
| Attachment 2 - Pricing Worksheet.xlsx | XLSX spreadsheet | |
| Attachment 5 Provisions and Clauses.pdf | ||
| Attachment 1 - PWS - 27 SOCONS VTC.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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