Attachment_H-_Conflict_of_Interest_Affidavit_and_Disclosure.pdf
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- Solicitation number
- BPM053865
- Issued by
- Washington County, Maryland
About this file
This is a Conflict of Interest Affidavit and Disclosure form required by the Maryland Department of Health for the Part-time Speech Therapist position at Potomac Center and SETT facilities in Hagerstown, Maryland, under IFB BPM053865. The affidavit requires offerors, contractors, consultants, and subcontractors to warrant that no relevant facts or circumstances exist that would create a conflict of interest, defined as circumstances preventing impartial assistance to the State or impairing objectivity in performing contract work. Bidders must disclose in detail any facts or circumstances that give rise or could potentially give rise to conflicts of interest, and must immediately notify the procurement officer in writing of any actual or potential conflicts that arise after the affidavit date, including a description of actions taken to avoid, mitigate, or neutralize such conflicts. The form requires the authorized representative to execute an affidavit under penalties of perjury confirming the truthfulness of the disclosure.
This document must be submitted with the bid or proposal and is executed by the authorized representative acting as affiant. The affidavit applies to all personnel with authority to control or supervise the contract work, including employees and agents of the offeror, contractor, or any subcontractor or sub-consultant at any tier. The procurement officer retains authority to determine appropriate actions regarding disclosed conflicts, and contractors must continue performance of awarded contracts until receiving contrary notification from the procurement officer.
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Text version
Attachment H – Conflict of Interest Affidavit Page H-1 effective date: April 17, 2018
Attachment H. Conflict of Interest Affidavit and Disclosure
Reference COMAR 21.05.08.08
A. “Conflict of interest” means that because of other activities or relationships with other persons, a person is unable or potentially unable to render impartial assistance or advice to the State, or the person’s objectivity in performing the contract work is or might be otherwise impaired, or a person has an unfair competitive advantage.
B. “Person” has the meaning stated in COMAR 21.01.02.01B (64) and includes a Offeror, Contractor, consultant, or subcontractor or sub-consultant at any tier, and also includes an employee or agent of any of them if the employee or agent has or will have the authority to control or supervise all or a portion of the work for which a Proposal is made.
C. The Offeror warrants that, except as disclosed in §D, below, there are no relevant facts or circumstances now giving rise or which could, in the future, give rise to a conflict of interest.
D. The following facts or circumstances give rise or could in the future give rise to a conflict of interest (explain in detail — attach additional sheets if necessary):
E. The Offeror agrees that if an actual or potential conflict of interest arises after the date of this affidavit, the Offeror shall immediately make a full disclosure in writing to the procurement officer of all relevant facts and circumstances. This disclosure shall include a description of actions which the Offeror has taken and proposes to take to avoid, mitigate, or neutralize the actual or potential conflict of interest. If the contract has been awarded and performance of the contract has begun, the Contractor shall continue performance until notified by the procurement officer of any contrary action to be taken.
I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE
CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE, INFORMATION, AND BELIEF.
Date: ____________________ By: ______________________________________
(Authorized Representative and Affiant)
SUBMIT THIS AFFIDAVIT WITH BID/PROPOSAL
File details come from the government source that posted it. Updated .