Attachment C Exhibit 3 - Individual COI and NDA Revised 02.docx

Exhibit 3

INDIVIDUAL CONFLICT OF INTEREST AND NON-DISCLOSURE AGREEMENT

This form shall be completed and signed by each Contractor employee, subcontractor employee, teaming-partner employee, consultant, affiliate personnel member, or other individual who is provided access to nonpublic information or documents relating to a Task Order or a prospective Task Order under Contract No. ____________________.

Contractor: _______________________________________________________________ Contract Number: __________________________________________________________ Task Order Number: ________________________________________________________ Task Order Title/Location: __________________________________________________ Individual’s Name: _________________________________________________________ Employer/Organization: _____________________________________________________ Title/Role: ________________________________________________________________ A. Conflict of Interest I have read and understand the conflict-of-interest requirements in the solicitation and resulting contract, including the organizational and personal conflict-of-interest restrictions applicable to this Task Order. I agree to comply with those requirements.

I certify that I will promptly disclose to the Contractor and the Government any actual, potential, or apparent organizational conflict of interest, personal financial interest, business relationship, representation, affiliation, or other circumstance that could impair, or reasonably appear to impair, my objectivity or my ability to perform assigned duties impartially.

I understand that I may not represent, assist, advise, or otherwise support a private lessor, developer, offeror, prospective offeror, or other interested party in connection with the VA lease acquisition supported by this Task Order, unless specifically authorized in writing by the Contracting Officer.

B. Non-Disclosure and Protection of Procurement Information I understand that, in performing work under this Task Order, I may receive or obtain access to contractor bid or proposal information, proprietary information, source-selection information, or other nonpublic procurement-sensitive information.

I will protect such information from unauthorized use or disclosure and will use it only for the purpose for which it was furnished and only as necessary to perform authorized duties under this Task Order. I will not disclose such information to any person or entity unless that person or entity is authorized to receive it by the Contracting Officer, Lease Contracting Officer, or other authorized Government official.

I understand that unauthorized disclosure or use of contractor bid or proposal information or source-selection information may violate 41 U.S.C. chapter 21 and FAR 3.104 and may result in contractual, civil, criminal, administrative, or other remedies permitted by law.

C. Proprietary Information I understand that information submitted by offerors or prospective offerors in response to a Request for Lease Proposals, solicitation, or other procurement request may be proprietary, confidential, or otherwise protected from disclosure.

Consistent with FAR 9.505-4 and applicable solicitation and contract requirements, I will protect proprietary information received from other companies from unauthorized use or disclosure for as long as it remains proprietary.

D. Continuing Obligation and Reporting My obligations under this agreement continue during and after my participation in this Task Order. I will immediately report any suspected unauthorized disclosure, misuse, loss, compromise, or conflict of interest to my supervisor and to the Contracting Officer, Lease Contracting Officer, or Contracting Officer’s Representative, as appropriate.

I certify that I have read, understand, and agree to comply with this agreement.

Typed Name: ______________________________________________________________ Signature: ________________________________________________________________ Date: _____________________________________________________________________ Title/Role: ________________________________________________________________ Employer/Organization: _____________________________________________________ image1.jpg