Attachment-I.-Conflict-of-Interest-Affidavit-and-Disclosure.pdf
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- Solicitation number
- BPM058293
- Issued by
- Washington County, Maryland
About this file
This is a Conflict of Interest Affidavit and Disclosure form for the Maryland Department of Health's janitorial staffing services contract opportunity for the Potomac Center and Secure Evaluation & Therapeutic Treatment (SETT) facility in Hagerstown, Maryland. The affidavit requires offerors, contractors, consultants, subcontractors, and their employees or agents with authority to control or supervise contract work to declare the absence of conflicts of interest or to fully disclose any relevant facts or circumstances that could give rise to actual or potential conflicts. The contract seeks to provide three full-time janitorial staff members (eight hours per day, five days per week) to perform daily cleaning and housekeeping tasks at the Potomac Center, which has 62 licensed beds, and SETT, a secure forensic facility with 32 licensed beds. Work shall be performed between 8:00 a.m. and 4:30 p.m., Monday through Sunday, excluding state holidays and inclement weather closures, with potential for additional evening and weekend hours for special projects. The contract term is seventeen weeks, approximately four months.
The affidavit must be signed under penalty of perjury by an authorized representative and submitted with the bid or proposal. Offerors warrant that except as disclosed in the form, no relevant facts or circumstances exist that would create a conflict of interest. Should an actual or potential conflict of interest arise after execution of the affidavit, offerors must immediately provide written disclosure to the procurement officer detailing all relevant facts and circumstances and describing actions taken or proposed to avoid, mitigate, or neutralize the conflict. If a contract has been awarded and performance has begun, the contractor shall continue performance until notified otherwise by the procurement officer. The form references COMAR 21.05.08.08 and applies regulations from COMAR 21.01.02.01B(64) regarding the definition of "person" in state procurement contexts.
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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 .