Attachment-I.-Conflict-of-Interest-Affidavit.pdf
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- Attached to
- ODSPHS - Public Health Leadership and Change Management Training and Technical Assistance
- Solicitation number
- BPM057811
- Issued by
- Maryland
About this file
This is a Conflict of Interest Affidavit form for the Maryland Department of Health's Office of the Deputy Secretary for Public Health Services related to the procurement of Public Health Leadership and Change Management Training and Technical Assistance. The affidavit is required to be completed by vendors or their representatives to disclose any potential conflicts of interest in relation to the contract opportunity. The form serves as a certification mechanism to ensure vendor impartiality and compliance with state procurement regulations governing conflicts of interest in contractor relationships with the Maryland Department of Health.
The affidavit requires disclosure of any direct or indirect financial interests, familial relationships, or business affiliations that could create conflicts with the Department's interests or compromise the vendor's objectivity in providing leadership and change management training services to the estimated 35 public health participants. Completion and submission of this conflict of interest affidavit is a standard procurement requirement and submission deadline and specific instructions regarding notarization or authentication would be outlined in the primary solicitation documents and contract terms.
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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
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