Attachment C - Conflict of Interest Certification.pdf

ATTACHMENT C FORENSIC FINANCIAL REVIEW AND AUDITING SERVICES RFP #2026-FA01

Attachment C — RFP #2026-FA01 — Culpeper County, Virginia

ATTACHMENT C

Conflict of Interest Certification

Culpeper County, Virginia

Virginia Code §§ 2.2-4367 through 2.2-4377

The Virginia Public Procurement Act (Article 6, §§ 2.2-4367 through 2.2-4377, Code of Virginia) and the Culpeper County Purchasing Resolution (Article 9) establish standards of ethical conduct governing the conduct of persons participating in public procurement transactions. These standards apply to the offeror, its officers, directors, partners, employees, agents, and subcontractors.

PART 1 — CONFLICT OF INTEREST DISCLOSURE

The offeror must disclose any current or past relationship with Culpeper County, the Town of Culpeper, any member of the Culpeper County Board of Supervisors, the County Administrator (or Acting County Administrator), the County Attorney, or any senior County official that could create an actual, potential, or perceived conflict of interest. Disclose any financial, familial, or organizational relationship below:

☐ The offeror has NO conflicts of interest to disclose.

☐ The offeror discloses the following relationships (describe below):

PART 2 — INDEPENDENCE CONFIRMATION

Given the forensic nature of this engagement and the requirement for independence under Government Auditing Standards (Yellow Book, 2024 Revision), Chapter 3, the offeror must confirm the following:

☐ The firm and all proposed personnel have no existing audit, consulting, advisory, or other professional relationship with Culpeper County or the Town of Culpeper that would create an independence impairment under Government Auditing Standards Chapter 3.

☐ The firm has not provided bookkeeping, financial statement preparation, internal audit outsourcing, IT system design or implementation, or management advisory services to Culpeper County during the audit period in scope (FY 2022 through FY 2026 year-to-date).

☐ No member of the engagement team has a personal, familial, or financial relationship with any current or former County officer or employee that would impair independence.

☐ The firm will immediately notify the County Attorney of any change in circumstances that could affect independence during the term of the engagement.

PART 3 — ETHICS IN PUBLIC CONTRACTING CERTIFICATION

By signing below, the offeror certifies that:

☐ The offeror has not offered or conferred any payment, loan, subscription, advance, deposit of money, services, or anything of more than nominal value to any public employee having official responsibility for this procurement transaction.

☐ The offeror has not engaged in any activity that would constitute a violation of Virginia Code §§ 2.2-4367 through 2.2-4377 or Article 9 of the Culpeper County Purchasing Resolution.

☐ No person who has prepared specifications or served in an advisory capacity for this solicitation is affiliated with the offeror.

☐ The offeror understands that a willful violation of the ethics provisions is a Class 1 misdemeanor and that any public employee convicted shall forfeit their employment (Virginia Code § 2.2-4377).

CERTIFICATION

I certify that I have read and understand the provisions of Virginia Code §§ 2.2-4367 through 2.2-4377 and Article 9 of the Culpeper County Purchasing Resolution, and that the information provided herein is true, complete, and accurate. I understand that any material misrepresentation may result in disqualification, contract termination, debarment, and/or criminal prosecution.

Firm Name: _________________________________________________________________________

Signature:

Printed Name:

Title:

Date: