Attachment 4 - Conflict of Interest Statement.pdf
PDF 186 KB Posted
- Attached to
- FA485526Q0027 - Building 1265 Boiler Replacement
- Solicitation number
- FA485526Q0027
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 that the Government prohibits awarding contracts to Government employees or organizations owned, substantially owned, or controlled by one or more Government employees, as defined in 5 U.S.C. 2105. Bidders must certify one of two statements: either that neither the signatory nor any company owner or controller is a Government employee, or that the signatory or a company owner/controller is a Government employee. The form requires signatories to commit to disclosing any actual or potential conflicts of interest that arise during contract performance and to cooperate with mitigation measures. Signatories must also agree to comply with all applicable federal ethics, procurement integrity, and conflict of interest regulations under RFO subparts 3.6 and 9.5, as well as any agency-specific requirements. The statement requires completion by an individual with authority to legally bind the company, made under penalty of perjury, with fields for name, organization, date, phone, email, and signature.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: _______________________________
| Group1: Off |
| Text2: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
File details come from the government source that posted it. Updated .