Attachment A - Conflict of Interest Statement.pdf
PDF 148 KB Posted
- Attached to
- 212-25-010-CSW Dining Services RFP
- Solicitation number
- 84456
- Issued by
- Chesterfield County, Virginia
About this file
This is a Conflict of Interest Statement (Attachment A) for Virginia State University's RFP 212-25-010-CSW for Dining Services. This form requires offerors to disclose any potential conflicts of interest with the Commonwealth of Virginia.
The document requires offerors to provide basic contact information including name, address, city/state, and telephone number. The key component is a declaration of whether any member of the firm is an employee of the Commonwealth of Virginia who has a personal interest in the contract pursuant to Code of Virginia, Section 2.1-639.1-639.24. The form requires a yes/no response and explanation if "yes" is selected. The statement must be signed and dated by the offeror, with failure to furnish this information potentially resulting in the offer being declared non-responsive.
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Text version
Virginia State University RFP 212-25-010-CSW Dining Services
46 | P a g e
Ensure that the solicitation is thoroughly read and completed. Complete, sign and return the information requested below with your offer. FAILURE TO FURNISH THIS DATA MAY RESULT IN DECLARING YOUR
OFFER NON-RESPONSIVE.
ATTACHMENT A
Conflict of Interest Statement
NAME: _____________________________________________________________________________
ADDRESS: ___________________________________________________________________________
CITY/STATE: _________________________________________________________________________
TELEPHONE NUMBER: _________________________________________________________________
RELATIONSHIP QITH THE COMMONWEALTH OF VIRGINIA:
IS ANY MEMBER OF THE FIRM AN EMPLOYEE OF THE COMMONWEALTH OF VIRGINIA WHO HAS A
PERSONAL INTEREST IN THIS CONTRACT PURSUANT TO THE CODE OF VIRGINIA, SECTION 2.1-639.1 - 639.24
( ) YES ( ) NO
IF YES, EXPLAIN: ________________________________________________________________________
SIGNATURE OF OFFEROR DATE
File details come from the government source that posted it. Updated .