Attachment-I.-Conflict-of-Interest-Affidavit-and-Disclosure.pdf
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- Attached to
- Part-time Lifeguard for MDH Potomac Center
- Solicitation number
- BPM057289
- 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 (MDH) for a part-time Lifeguard position at the Potomac Center facility in Hagerstown, Maryland. The affidavit establishes that offerors, contractors, consultants, subcontractors, and their employees or agents must disclose any circumstances that could create conflicts of interest, defined as situations where a person is unable to render impartial assistance to the State or where their objectivity in performing contract work might be impaired. The contract term is 52 weeks, requiring the lifeguard to work approximately 12 to 14 hours per week on a fixed schedule: every Tuesday from 8:00 a.m. to 11:00 a.m. and 1:00 p.m. to 5:00 p.m., every Thursday from 1:00 p.m. to 5:00 p.m., and every other Thursday from 10:00 a.m. to 12:00 p.m. and 1:00 p.m. to 5:00 p.m., totaling 676 hours over the contract period.
All parties to the proposal warrant that no conflicts of interest exist except as specifically disclosed in the affidavit, and they must immediately notify the procurement officer in writing if any actual or potential conflicts arise after submission. The affidavit must be signed under penalty of perjury by an authorized representative and submitted with the bid or proposal. Applicants for this position must be Certified Pool Operators and will be responsible for lifeguard services, CPR and first aid provision, safety inspections, facility cleaning, and pool chemical maintenance for intellectually disabled residents at the Potomac Center.
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Text version
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
File details come from the government source that posted it. Updated .