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United States Department of Justice

Confidentiality Agreement for Contractor and Sub-Contractor Employees

I. I _________________________, do solemnly swear (or affirm) that I understand the high standards of trustworthiness and integrity required of me regarding materials and information that may come to my attention concerning Government contract, while I am an employee of

II. Except as necessary in the performance of my duties under this contract, I will not:

A. Reveal, divulge, or publicize any matters dealt with under the contract.

B. Disseminate any oral or written information obtained because of the execution of this contract or performance of work hereunder.

C. Remove any documents from the place of contract performance, except as approved in advance by the Contracting Officer's Technical Representative.

Furthermore, while employed on this contract, I will abide by the rules and regulations governing the standards of conduct of Justice Department employees, as outlined in DOJ regulations. In addition, I have read and will abide by the provisions of Section C.15 of this contract.

Signature Date

III. As a Contractor or Subcontractor employee on this contract, I understand that all materials provided by the Government, including any copies, notes or working papers derived or produced, are the property of the government. If required to do so by the Contracting Officer, I will promptly surrender such materials and derived copies, notes and/or working papers that are in my custody or control. I understand that my failure to surrender such materials promptly, or my conversion of such materials to a use not called for by the contract (e.g. delivery of a document, or a copy of it, or notes containing information taken from the document, to someone not working on this contract), may be a violation of 18 U.S.C. 641 (theft of Government property) and may subject me to fines (up to $10,000) and imprisonment (up to ten years).

IV. These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by existing statute or Executive order relating to

(1) classified information, (2) communications to Congress, (3) the reporting to an Inspector General of a violation of any law, rule, or regulation, or mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety, or (4) any other whistleblower protection. The definitions, requirements, obligations, rights, sanctions, and liabilities created by controlling Executive orders and statutory provisions are incorporated into this agreement and are controlling.

V. Following contract provisions, this Agreement may be formally modified or changed by the Government in those instances in which the courts (e.g. grand jury investigation), statutory requirements (e.g. civil investigative demands), or specific circumstances dictate such a modification or change.

CONFIDENTIALITY CERTIFICATION

Solicitation No.

The undersigned acknowledges that data or information to which he/she has access by reason of assigned duties in connection with this procurement is subject to the provisions and prohibitions contained in Section 27 of the Office of Federal Procurement Policy Act (41 USC 423), as amended.

He/She agrees not to disclose any information, privileged or otherwise, regarding this procurement to any person outside the government nor to any government employee or official who does not have an official "need to know" in connection with assigned duties.

In addition, the undersigned acknowledges that 18 USC 1905, a criminal statute, prohibits any officer or employee of the United States from disclosing or divulging certain kinds of business, confidential, or trade secret information unless authorized by law.

Signed

Typed Name

Organization

Job Title

Date Signed

CONFLICT OF INTEREST CERTIFICATION

Solicitation No.

I, , hereby certify that, to the best of my knowledge, neither I nor my spouse, dependent child, general partner, or any organization which I am serving as an officer, director, trustee, general partner, or employee, or any person or organization with whom I am negotiating or have an arrangement concerning prospective employment, has a financial interest in this matter.

I further certify to the best of my knowledge that this matter will not affect the financial interests of any member of my household. Also, to the best of my knowledge, no member of my household; no relative with whom I have a close relationship; no one with whom my spouse, parent or dependent child has or seeks employment; and no organization with which I am seeking a business relationship nor which I now serve actively or have served within the last year are parties or represent a party to the matter.

I also acknowledge my responsibility to disclose the acquisition of any financial or personal interest as described above that would be affected by the matter, and to disclose any interest I, or anyone noted above, has in any person or organization that does become involved in, or is affected at a later date by, the conduct of this matter.

Signed

Typed Name

Organization

Job Title

Date Signed

Privacy Act Statement

Title I of the Ethics in Government Act of 1978 (5 U.S.C. App.), Executive Order 12674 and 5 CFR Part 2634, Subpart I require the reporting of this information. The primary use of the information on this form is for review by officials of the Justice Department to determine compliance with applicable federal conflict of interest laws and regulations. Additional disclosures of the information on this report may be made: (1) to a federal, state or local law enforcement agency if the Justice Department becomes aware of a violation or potential violation of law or regulations; (2) to a court or party in a court or federal administrative proceeding if the government is a party or in order to comply with a judge-issued subpoena; (3) to a source when necessary to obtain information relevant to a conflict of interest investigation or decision; (4) to the National Archives and Records Administration or the General Services Administration in records management inspections; (5) to the Office of Management and Budget during legislative coordination on private relief legislation; and (6) in response to a request for discovery or for the appearance of a witness in a judicial or administrative proceeding, if the information is relevant to the subject matter. This confidential certification will not be disclosed to any requesting person unless authorized by law. See also the OGE/GOVT-2 executive branch wide Privacy Act system of records.

CONFIDENTIALITY CERTIFICATION

CONFLICT OF INTEREST CERTIFICATION

10.0.2.20120224.1.869952

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