Attachment_P_Conflict_of_Interest_Disclosure_Statement.PDF
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- Solicitation number
- DCAM-26-CS-RFP-0011
- Issued by
- District of Columbia
About this file
This is a Conflict of Interest Disclosure Statement form issued by the District of Columbia Department of General Services (DGS) for the Design-Build Services for Hendley ES Modernization project. Offerors and their teams are required to disclose all relevant facts relating to past, present, or planned interests that may result in or be viewed as organizational conflicts of interest in connection with the Request for Proposals. The form mandates disclosure of current contractual relationships with the Department, past, present, or planned contractual or employment relationships with any Department officer or employee, and any other circumstances that might create a financial interest in the contract award. Additionally, offerors must disclose matters such as shared directors with individuals or entities involved in preparing the RFP, as well as contractual relationships including joint ventures with such individuals or entities.
The certification section requires the undersigned to attest that, to the best of their knowledge and belief, no conflicts of interest exist beyond those disclosed on the statement. This disclosure requirement applies to the offeror, principal and major participants, proposed subconsultants and subcontractors, and their respective chief executives, directors, and other key personnel for the Project. The form references 27 DCMR 4705 and 4707 of the Department of General Services Procurement Rules for Construction and Related Services as the governing regulatory framework. Offerors must complete this form and submit it as part of their proposal package to ensure compliance with District procurement regulations and to identify any parties that may be prohibited from participating in the project due to prior involvement in the RFP preparation.
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CONFLICT OF INTEREST DISCLOSURE STATEMENT
Offeror’s Name: (“Offeror(s)”)
Offeror’s attention is directed to 27 DCMR §§ 4705 and 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.
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Date
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