Attachment_H-Conflict_of_Interest_Disclosure_Statement.PDF
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- Attached to
- REQUEST FOR QUALIFICATIONS CONSTRUCTION PROJECTS
- Solicitation number
- DCAM-26-CS-RFQ-0006
- Issued by
- District of Columbia
About this file
This is a Conflict of Interest Disclosure Statement form issued by the District of Columbia Department of General Services (DGS) for a Request for Qualifications (RFQ) related to construction projects. The RFQ solicits Statements of Qualifications from offerors interested in performing construction work for the District of Columbia Public Schools (DCPS), Department of Park and Recreation (DPR), and municipal facilities during the 2027-2032 fiscal years. The construction projects encompass building repairs, upgrades, and tenant-fit-out improvements including patching, plumbing, carpentry, masonry, electrical, HVAC, elevator work, and small park and playground projects across DCPS, DPR, and municipal sites. Offerors must meet all RFQ requirements and hold applicable licenses as determined by the District's Department of Building (DOB).
Qualified contractors will be pre-selected to compete for construction projects through a Blanket Operating Agreement (BOA) that establishes general terms and conditions, with specific work to be awarded through Task Order Agreements. The Conflict of Interest Disclosure Statement requires offerors to disclose all relevant facts regarding past, present, or planned interests that may result in organizational conflicts of interest, including current contractual relationships with the Department, employment relationships with Department officers or employees, financial interests in the agreement, common directors with RFP preparers, and contractual relationships with entities involved in preparing the RFP. Offerors must certify under the disclosure statement that, to the best of their knowledge and belief, no interests requiring disclosure exist other than those explicitly stated on the form.
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Text version
CONFLICT OF INTEREST DISCLOSURE STATEMENT
Offeror’s Name: (“Offeror(s)”)
Offeror’s attention is directed to 27 DCMR §§ 4705 and 4707 of the Department of General Services Procurement Rules for Construction and Related Services regarding organizational conflicts of interest (“Organizational Conflicts of Interest”). Offerors are advised that certain firms will not be allowed to participate in the Project or on any Offeror’s team for the Project because of their work with the Department in connection with the Project procurement.
(Initially capitalized terms not otherwise defined herein shall have the meanings set forth in the Agreement or the RFP).
Required Disclosure of Conflicts
In the space provided below identify all relevant facts relating to past, present, or planned interest(s) of the Offeror’s team (including the Offeror, principal/major participants, proposed subconsultants and proposed subcontractors, and their respective chief executives, directors, and other key personnel for the Project) which may result, or could be viewed as, an Organizational Conflict of Interest in connection with the RFP.
Offeror should disclose: (a) any current contractual relationships with the Department, (b) any past, present, or planned contractual or employment relationships with any officer or employee of Department, and (c) any other circumstances that might be considered to create a financial interest in the Agreement by any Department member, officer or employee if Offeror is awarded the Contract. Offeror should also disclose matters such as having directors in common with any of the individuals or entities involved in preparing the RFP. Offeror should also disclose contractual relationships (i.e. Joint Ventures) with any of the individuals or entities involved in preparing the RFP, as well as relationships wherein such individual or entity is a contractor or consultant (or subcontractor or subconsultant) to Offeror or a member of Offeror’s team. The foregoing is provided by way of example, and shall not constitute a limitation on the disclosure obligations.
Certification
The undersigned hereby certifies that, to the best of his or her knowledge and belief, no interest exists that is required to be disclosed in this Conflict of Interest Disclosure
Statement, other than as disclosed above.
Signature
Name
Title
Company Name
Date
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