Attachment I Conflict of Interest Affidavit and Disclosure.pdf
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- Attached to
- Vehicle Modification CS#25-24
- Solicitation number
- BPM054513
- Issued by
- Maryland
About this file
This is a Conflict of Interest Affidavit and Disclosure form required by the Maryland State Department of Education, Division of Rehabilitation Services (DORS) for the Vehicle Modification CS#25-24 solicitation. The affidavit applies to offerors, contractors, consultants, and subcontractors at any tier, as well as their employees and agents with authority to control or supervise work on the contract. The selected vendor will complete modifications to a 2025 GMC Sierra in accordance with the Vehicle Equipment Adaptation Prescription Agreement (VEAPA) specifications. The contract is anticipated to begin on or about January 12, 2026 and will expire July 12, 2026. The bidder must be certified by the National Mobility Equipment Dealer's Association (NMEDA) Quality Assurance Program (QAP) and provide a current NMEDA certificate as proof of qualification.
Offerors must warrant that no relevant facts or circumstances exist that would create a conflict of interest, or alternatively disclose any such conflicts in detail on the affidavit. Offerors are further obligated to immediately disclose in writing to the procurement officer any actual or potential conflicts of interest that arise after the affidavit date, including a description of actions taken or proposed to avoid, mitigate, or neutralize such conflicts. The affidavit must be completed under the penalties of perjury by an authorized representative and submitted with the bid or proposal. The form references COMAR 21.05.08.08 and COMAR 21.01.02.01B(64) for regulatory definitions of conflict of interest and person.
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Attachment I. Conflict of Interest Affidavit effective date: July 2024
Attachment I. 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
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