Attachment B-Disclosure Exemption.pdf

Bid Solicitation # S-10000-00006578 ODHS # 5651 Disclosure Exemption Affidavit Page 1 of 3

EXATTACHMENT B — DISCLOSURE EXEMPTION AFFIDAVIT

Attachment B is completed only when an Applicant wants to exempt information in the Application from public disclosure under the Public Records Law.

_____________________________________________________________, (the “Affiant”), being first duly sworn under oath, and representing _____________________________________________________, (hereafter “Applicant”), hereby deposes and swears or affirms under penalty of perjury that:

1. I am an employee of the Applicant, I have knowledge of the Request for Application referenced herein, and I have full authority from the Applicant to submit this affidavit and accept the responsibilities stated herein.

2. I am aware that the Applicant has submitted an Application, dated on or about ________________________ (the “Applicant”), to the State of Oregon (State) in response to Request for Application number S-0000-00006578, for a consultant for organizational change services, and I am familiar with the contents of the RFP and Application.

3. I have read and am familiar with the provisions of Oregon’s Public Records Law, Oregon Revised Statutes (“ORS”) 192.311 through 192.478, and the Uniform Trade Secrets Act as adopted by the State of Oregon, which is set forth in ORS 646.461 through ORS 646.475. I understand that the Application is a public record held by a public body and is subject to disclosure under the Oregon Public Records Law unless specifically exempt from disclosure under that law.

4. I have reviewed the information contained in the Application. The Applicant believes the information listed in Exhibit A of this Attachment B is exempt from public disclosure (collectively, the “Exempt Information”), which is incorporated herein by this reference. It is my opinion that the Exempt Information is exempt from disclosure under Oregon’s Public Records Law under the specifically designated sections as set forth in Exhibit A or constitutes “Trade Secrets” under either the Oregon Public Records Law or the Uniform Trade Secrets Act as adopted in Oregon because that information is either:

a. A formula, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information that:

(1) is not patented,

(2) is known only to certain individuals within the Applicant’s organization and that is used in a business the Applicant conducts,

(3) has actual or potential commercial value, and

(4) gives its user an opportunity to obtain a business advantage over competitors who do not know or use it.

or

b. Information, including a drawing, cost data, customer list, formula, pattern, compilation, program, device, method, technique, or process that:

(1) Derives independent economic value, actual or potential, from not being generally known to the public or to other persons who can obtain economic value from its disclosure or use; and

Bid Solicitation # S-10000-00006578 ODHS # 5651 Disclosure Exemption Affidavit Page 2 of 3

(2) Is the subject of efforts by the Applicant that are reasonable under the circumstances to maintain its secrecy.

5. I understand that disclosure of the information referenced in Exhibit A may depend on official or judicial determinations made in accordance with the Public Records Law.

Submission of this Attachment C, with the signature of the Affiant, and notarization of the signature, is only required if there is information listed on page 3.

Affiant’s Signature _________________________________________________________________________________

State of ________________________ )

) ss:

County of _____________________ )

Signed and sworn to before me on _________________ by __________________________________________ Date Affiant’s name

Notary Public for the State of _________________

My Commission Expires: ________________________

Notary’s Signature

Bid Solicitation # S-10000-00006578 ODHS # 5651 Disclosure Exemption Affidavit Page 3 of 3

EXHIBIT A TO ATTACHMENT B

Applicant identifies the following information as exempt from public disclosure under the following designated exemption(s):