Attachment_P_-_Conflict_of_Interest_Disclosure_Statement.pdf
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- Solicitation number
- DCAM-26-CS-RFP-0006
- Issued by
- District of Columbia
About this file
This is a Conflict of Interest Disclosure Statement for the District of Columbia Department of General Services (DGS) Design-Build Services for the New River Terrace Recreation Center project located at 500 36th Street NE in Ward 7, Washington, DC 20019. The disclosure statement requires offerors and their team members, including principal participants, proposed subconsultants, subcontractors, chief executives, directors, and key personnel, to identify all relevant facts relating to past, present, or planned interests that may result in or be viewed as an organizational conflict of interest in connection with the RFP. Offerors must disclose any current contractual relationships with DGS, past, present, or planned contractual or employment relationships with any DGS officer or employee, and any other circumstances that might create a financial interest in the agreement by any Department member, officer, or employee if the offeror is awarded the contract.
The disclosure obligations extend to matters such as having directors in common with individuals or entities involved in preparing the RFP, as well as contractual relationships including joint ventures with such individuals or entities, or relationships wherein such individuals or entities serve as contractors, consultants, subcontractors, or subconsultants to the offeror or its team members. The undersigned certifies that, to the best of their knowledge and belief, no interest exists that is required to be disclosed other than as explicitly stated in the document. The certification requires the signature, name, title, company name of the authorized representative, and the date of submission, which must be dated in 2022.
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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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