Attachment_P_-_Conflict_of_Interest_Disclosure_Statement.pdf
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- Solicitation number
- DCAM-26-CS-RFP-0005
- Issued by
- District of Columbia
About this file
This is a Conflict of Interest Disclosure Statement form required by the District of Columbia Department of General Services for offerors responding to the Design-Build Services Request for Proposals for the Anacostia Recreation Center Pool Replacement Project. The form mandates that all offerors disclose relevant facts relating to past, present, or planned interests of their team members—including the offeror, principal participants, proposed subconsultants and subcontractors, and their respective key personnel—that may result in or be perceived as an organizational conflict of interest. Specifically, offerors must disclose any current contractual relationships with the Department, any past, present, or planned contractual or employment relationships with Department officers or employees, and any circumstances that might create a financial interest in the agreement for any Department member. Additionally, offerors must disclose matters such as shared directors with individuals or entities involved in preparing the RFP and contractual relationships, including joint ventures, with such individuals or entities. The certification section requires the authorized signatory to attest that, to the best of their knowledge and belief, no interest exists that requires disclosure under the statement, other than as disclosed on the form.
The form serves as a critical compliance document within the District's procurement framework, which is governed by Section 4705 and Section 4707 of the Department of General Services Procurement Rules for Construction and Related Services. Certain firms are explicitly prohibited from participating in the Project or joining any offeror's team based on their prior work with the Department in connection with the Project procurement. The statement operates as a prerequisite certification mechanism ensuring transparency and preventing conflicts of interest that could compromise the integrity of the competitive procurement process for this $13,000,000 design-build project scheduled for completion by May 3, 2027.
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Text version
CONFLICT OF INTEREST DISCLOSURE STATEMENT
Offeror’s Name: (“Offeror(s)”)
Offeror’s attention is directed to Section 4705 and Section 4707 of the Department of General
Services Procurement Rules for Construction and Related Services regarding organizational conflicts of interest (“Organizational Conflicts of Interest”). Offerors are advised that certain firms will not be allowed to participate in the Project or on any Offeror’s team for the Project because of their work with the Department in connection with the Project procurement.
(Initially capitalized terms not otherwise defined herein shall have the meanings set forth in the
Agreement or the RFP).
Required Disclosure of Conflicts
In the space provided below identify all relevant facts relating to past, present, or planned interest(s) of the Offeror’s team (including the Offeror, principal/major participants, proposed subconsultants and proposed subcontractors, and their respective chief executives, directors, and other key personnel for the Project) which may result, or could be viewed as, an Organizational
Conflict of Interest in connection with the RFP.
Offeror should disclose: (a) any current contractual relationships with the Department, (b) any past, present, or planned contractual or employment relationships with any officer or employee of Department, and (c) any other circumstances that might be considered to create a financial interest in the Agreement by any Department member, officer or employee if Offeror is awarded the Contract. Offeror should also disclose matters such as having directors in common with any of the individuals or entities involved in preparing the RFP. Offeror should also disclose contractual relationships (i.e. Joint Ventures) with any of the individuals or entities involved in preparing the RFP, as well as relationships wherein such individual or entity is a contractor or consultant (or subcontractor or subconsultant) to Offeror or a member of Offeror’s team. The foregoing is provided by way of example, and shall not constitute a limitation on the disclosure obligations.
Certification
The undersigned hereby certifies that, to the best of his or her knowledge and belief, no interest exists that is required to be disclosed in this Conflict of Interest Disclosure
Statement, other than as disclosed above.
Signature
Name
Title
Company Name
, 2022 Date
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