Attachment 4 - Conflict of Interest Statement.pdf
PDF 167 KB Posted
- Attached to
- Cannon AFB - 4625 Boiler
- Solicitation number
- FA485527Q0001
About this file
This is a Conflict of Interest Statement form required under the Revolutionary FAR Overhaul (RFO) subpart 3.6, which governs contracts with Government employees or organizations owned or controlled by them.
The form requires a contractor representative with legal authority to certify under penalty of perjury whether the signatory or any company owner/controller is a Government employee as defined in 5 U.S.C. 2105. Two certification options are provided: one confirming no Government employee involvement, and an alternative confirming Government employee involvement. The form obligates the contractor to promptly disclose in writing to the Contracting Officer any actual or potential conflicts of interest arising during contract performance and to cooperate with mitigation measures. The contractor commits to compliance with all applicable federal ethics, procurement integrity, and conflict of interest regulations, specifically including RFO subpart 3.6 and RFO subpart 9.5, plus any agency-specific requirements. The completed form must include the signatory's name, date, organization, phone number, email address, and signature.
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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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