Attachment-I.-Conflict-of-Interest-Affidavit.pdf
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- Attached to
- R00B6600216 - Vehicle Equipment Adaptation Prescription Agreement (VEAPA) for DORS Client (CS #26-08)
- Solicitation number
- BPM057733
- Issued by
- Maryland
About this file
This is a Conflict of Interest Affidavit form for the State of Maryland, specifically applicable to the Division of Rehabilitation Services (DORS) Vehicle Equipment Adaptation Prescription Agreement (VEAPA) contract opportunity. The affidavit requires offerors, contractors, consultants, subcontractors, and their employees or agents with authority to control or supervise work to disclose any facts or circumstances that could create a conflict of interest, defined as situations where a person may be unable to render impartial assistance to the State, where objectivity in performing contract work could be impaired, or where an unfair competitive advantage exists. Offerors must warrant that no relevant facts giving rise to conflicts exist, except as disclosed in the form, and must provide detailed explanations of any potential conflicts with supporting documentation as needed.
The affidavit establishes an ongoing disclosure obligation requiring immediate written notification to the procurement officer if actual or potential conflicts arise after the form's execution, including a description of actions taken or proposed to mitigate the conflict. The document must be executed under penalties of perjury by an authorized representative and submitted with the bid or proposal. The form is effective as of July 2024 and references COMAR 21.05.08.08 and COMAR 21.01.02.01B(64) as regulatory authority. No specific pricing, set-asides, funding amounts, or contract term information is contained in this affidavit document.
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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
File details come from the government source that posted it. Updated .