Attachment O - Conflict of Interest Certification Form.doc

Conflict of Interest Certification

The Offeror ____________________________________ ________________________________________________________, hereby certifies that, to the best of their knowledge and belief, there are no present or currently planned interests (financial, contractual, organizational, or otherwise) relating to the work to be performed under the contract or task order resulting from Request for Proposal Number _____________________________________________________________________ that would create any actual or potential conflict of interest (or apparent conflicts of interest) (including conflicts of interest for immediate family members: spouses, parents, children) that would impinge on its ability to render impartial, technically sound, and objective assistance or advice or result in it being given an unfair competitive advantage. In this clause, the term “potential conflict” means reasonably foreseeable conflict of interest. The Contractor further certifies that it has and will continue to exercise due diligence in identifying and removing or mitigating, to the Government’s satisfaction, such Conflicts of Interest (or apparent conflicts of interest).

Offeror’s Name

RFP/Contract No.

Signature

Title

Date