Attachment C - CoC Conflict of Interest Certification~1.pdf
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- Solicitation number
- HE-25-615
- Issued by
- Los Angeles County, California
About this file
Long Beach Continuum of Care (CoC) Conflict of Interest Certification
This document is a Conflict of Interest Certification form for the Long Beach Continuum of Care (CoC), required for agencies requesting federal funds for homelessness assistance programs. The form establishes compliance with federal regulations under 2 CFR 200.318(c)(1) and 24 CFR 576.404, which prohibit employees, officers, agents, consultants, elected officials, and appointed officials of fund-recipient agencies from participating in selection, award, or administration of federally-funded contracts when real or apparent conflicts of interest exist. The certification applies to individuals who exercise functions or responsibilities with respect to HHAP-assisted activities, participate in decision-making processes, or are positioned to gain inside information regarding funded activities. The form requires agencies to disclose conflicts involving financial interests, family or business ties, or interests in contracts and subcontracts related to the funding application, with the prohibition extending for one year following employment tenure.
The certification form contains four yes-or-no questions addressing whether agency personnel can participate in approval decision-making, gain inside information, obtain financial benefits, or hold interests in contracts related to the funding application. If any question is answered affirmatively, applicants must submit a supplementary letter disclosing the nature and extent of the conflict, describing public disclosure methods, and providing a qualified attorney's opinion confirming that the conflict does not violate federal, state, or local law. The authorized agency official must sign and date the form, certifying the accuracy and completeness of all information presented.
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Long Beach Continuum of Care (CoC) Conflict of Interest Certification
Agency Name
Per the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards at the Code of Federal Regulations, Title 2 Part 200, Section 200.318 (2 CFR 318(c)(1)), no employee, officer, or agent shall participate in the selection, award or administration of a contract supported by Federal funds if a real or apparent conflict of interest would be involved. Such a conflict would arise when an employee, officer, or agency, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated herein, has a financial or other interest in the agency selected for an award.
The regulations at Code of Federal Regulations, Title 24, Section 576.404 (24 CFR 578.404) provide that no person who is an employee, agent, consultant, officer, or elected official, or appointed official of a recipient or subrecipient that are receiving CoC funds and (1) who exercises or has exercised any functions or responsibilities with respect to activities assisted with HHAP funds; or (2) who is in a position to participate in a decision-making process or gain inside information with regard to these activities, may obtain a financial interest from an HHAP-assisted activity, or have interest in any contract, subcontract, or agreement with respect thereto, or the proceeds there under, either themselves or those with whom they have family or business ties, during their tenure or for one (1) year thereafter.
A. Are any employees, agents, consultants, officers, family members, or elected officials of the agency requesting funds in a position to participate in the decision-making process for approval of this application?
Yes No
B. Are any employees, consultants, officers, family members, or elected officials of the agency requesting funds in a position to gain inside information with regard to approval of this application?
Yes No
C. Will any employees, agents, consultants, officers, family members, or elected officials of the agency requesting funds obtain a financial interest or substantial benefit from this activity?
Yes No
D. Will any employees, agents, consultants, officers, family members, or elected officials of the agency requesting funds have an interest in any contract, subcontract, or agreement with respect to funding this application, either for themselves or those with whom they have family or business ties during the program year and one year thereafter?
Yes No
If you answered “Yes” to any of the questions above, a letter must be submitted with the application that includes the following information:
1. A disclosure of the nature and extent of the conflict
2. A description of how public disclosure will be made
3. A qualified attorney’s opinion that the conflict of interest does not violate federal, state, or local law
I certify that, to the best of my knowledge and belief, all the information presented on and attached to this form is true, accurate and complete.
Signature of Authorized Agency Official Date
Name and Title of Signatory (please print)
I certify that, to the best of my knowledge and belief, all the information presented on and attached to this form is true, accurate and complete.
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