Attachment B - Certificate of Non-Disclosure and Conflict of Interest Statement.pdf

Revised August 2014

CERTIFICATE OF NON-DISCLOSURE

AND

CONFLICT OF INTEREST STATEMENT

Solicitation/Contract #_________________________________

I understand that in the course of my duties and responsibilities, I may have access to information received by the Government in confidence from non-Federal entities in connection with this acquisition including, but not necessarily limited to, technical approaches, past performance information, trade secrets, inventions, discoveries, and reports of a financial or technical nature and cost or pricing-related information. I may also have access to other procurement information such as the names, identities, or numbers of non-Federal entities under consideration or the methods or procedures used in the selection of a contractor, including, but not limited to, the standards and ratings used in the evaluation process. I understand that this and other information gained during the procurement process may constitute “source selection information” and “contractor bid and proposal information” as those terms are defined in FAR 2.101 and 3.104. I understand that federal law prohibits the unauthorized disclosure of such information. I agree not to disclose such information to any individual outside of the acquisition team members and advisors without the express authorization of the Contracting Officer responsible for the acquisition. I understand that my obligation not to disclose the information described above does not terminate with the award of a contract or any other contract action. I further understand that unauthorized disclosure of such information may result in disciplinary action, including termination of employment. If I am a military member, I understand that failure to comply with these conditions may result in disciplinary action under the Uniform Code of Military Justice.

I further affirm that I have reviewed my financial interests, and the interests of my spouse and minor children, and to the best of my knowledge those interests are not likely to create a real or apparent conflict of interest with my participation in this acquisition. In the event a proposal is received from firm in which I have a personal or financial interest of any nature, I will immediately notify the Contracting Officer. I acknowledge that the personal or financial interest may require my removal from further participation in this source selection. (Note that the interest of a spouse, minor child, or other member of an employee’s immediate household should be reported in the same manner as an interest of the panel member.)

These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by existing statute or Executive order relating to (1) classified information, (2) communications to Congress, (3) the reporting to an Inspector General of a violation of any law, rule, or regulation, or mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety, or (4) any other whistleblower protection. The definitions, requirements, obligations, rights, sanctions, and liabilities created by controlling Executive orders and statutory provisions are incorporated into this agreement and are controlling.

Member’s Name Printed: ________________________________

Member’s Signature: ________________________________ Date: _________