Attachment J.2 Non-Disclosure Agreement and Conflict of Interest Statement.docx

W900KK-22-R-0016

Attachment J.3 Non-Disclosure Agreement and Conflict of Interest Statement

Important! This Agreement concerns a matter within the jurisdiction of a United States government agency. Individuals who make false, fictitious, or fraudulent statements and/or certifications may be subject to prosecution under 18 U.S.C §1001.

AGREEMENT

1. This Agreement applies to individuals involved in the (insert name of Program/Acquisition), Solicitation (insert number, if known).

2. This Agreement contains the rules of conduct relating to this acquisition. It includes rules of conduct regarding conflicts of interest as well as rules of conduct regarding the safeguarding of confidential information.

3. Your signature on this Agreement indicates that you:

a. Have read this Agreement and agree to be bound by its terms;

b. Have been made aware of the following potential offeror(s) or subcontractor(s) that have either shown interest through market research, or responded to the subject solicitation: (insert list of all potential offeror(s) or subcontractor(s) found through sources such as market research, professional knowledge of the industry, Request for Information, Industry Days, and response to subject solicitation, etc.)

TERMS

4. I have read, understand, and will abide by the requirements of the Federal Acquisition Regulation (FAR) 3.104, Army FAR Supplement (AFARS) 5103.104. I understand that I may request a copy of FAR 3.104 and AFARS 5103.104 from the Contracting Officer for this acquisition.

5. To the best of my knowledge, neither I, my spouse, my dependent child(ren), nor any members of my household*:

a. Have any direct or indirect financial interest in any firm outside your current employer who may be a potential offeror or subcontractor in this acquisition.

b. Have any other beneficial interest in a potential offeror or subcontractor in this acquisition, except: ______________________________________________________________________________________________________________________________

6. To the best of my knowledge, no person related to me by blood or marriage, or any business associate, is employed by or has a direct or indirect financial interest or any other beneficial interest in any of the potential offerors or subcontractors in this acquisition except*: ______________________________________________________________________ ______________________________________________________________________

(*The listing of interests or activities under paragraphs 5 and 6 above does not mean that the employee cannot participate in the acquisition / source selection process. The effect of the interests / activities will be determined by the Contracting Officer after consultation with legal counsel.)

7. I understand that I may request a statement from the Contracting Officer as to whether a person or company is considered to be a potential offeror or proposed subcontractor.

8. I will not knowingly disclose any contractor bid or proposal information or source selection information regarding this acquisition directly or indirectly to any person other than a person authorized in accordance with AFARS 5103.104 to receive such information.

9. I will observe the following rules during the conduct of the acquisition:

a. I will not solicit or accept, directly or indirectly, any promise of future employment or business opportunity from, or engage, directly or indirectly, in any discussion of future employment or business opportunity with, any officer, employee, representative, agent, or consultant of any potential offeror or subcontractor for this acquisition.

b. I will not solicit or accept, directly or indirectly, any gratuity, gift, favor, entertainment, loan, or anything of monetary value from anyone who (a) has or is seeking to obtain Government business with the employee’s agency, (b) conducts activities that are regulated by the employee’s agency, or (c) has interests that may be substantially affected by the performance or nonperformance of the employee’s official duties. I will advise my family that the acceptance of a gratuity from those who are engaged in or seek to do business with the Department of Defense may be imputed to me, and must therefore be avoided.

c. I will instruct members of my parent or home organization not to divulge my participation in the evaluation and source selection process or my physical location while participating in the evaluation and source selection process to unauthorized persons.

d. I understand that all communications with offerors or their subcontractors concerning this acquisition must be made by/through the Contracting Officer, or the Contracting Officers’ designee. I will divert all attempted communications by offerors' or subcontractors’ representatives, or any other unauthorized person, to the Contracting Officer.

e. I will not discuss evaluation or source selection matters, including proposal information, with any unauthorized individuals (including Government personnel), even after the announcement of the successful contractor, unless authorized by the Contracting Officer or Source Selection Authority. All discussions of evaluation/source selection matters with other Source Selection Evaluation Board (SSEB) members shall be conducted solely in those areas designated for deliberations.

10. I realize that my actions in connection with my participation in this source selection are subject to intense scrutiny and I will conduct myself in a way that will not adversely affect the confidence of the public in the acquisition process. I will avoid any action, whether or not prohibited, that could result in or create the appearance of my losing independence or impartiality. I will not use my public office for private gain, and I agree not to engage in any personal business or professional activity, or enter into any financial transaction, that involves or appears to involve, the direct or indirect use of "inside information" to further a private gain for myself or others.

11. I understand that my obligations under this certification are of a continuing nature, and if anything takes place which would cause a change to any statement, or create a violation of any representation or rule of conduct herein, I will immediately bring such matter to the attention of the Chairperson of the SSEB, or the Contracting Officer.

CERTIFICATION

12. I agree to the Terms of this Agreement and certify that I have read and understand the above Agreement. I further certify that the statements made herein are true and correct.

Signature Name (Printed) Organization & Title