ESBD_469833_1763151245010_Exhibit D - Conflict of Interest Disclosure 301-26-06531.pdf
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- Attached to
- FOREIGN TRADE AND INVESTMENT REPRESENTATION SERVICES FOR THE STATE OF TEXAS ISRAEL OFFICE
- Solicitation number
- 301-26-06531
- Issued by
- Texas
About this file
Conflict of Interest Disclosure Form for RFP No. 301-26-06531
This document is a Conflict of Interest Disclosure and Certification form required for submission with proposals in response to RFP No. 301-26-06531. The form mandates that respondents certify their understanding of conflict of interest provisions, contract certifications, and applicable statutes referenced in the RFP, specifically sections addressing prohibited bids and contracts, gifts to public servants, conflicts of interest disclosure, and compliance with applicable laws. Respondents must disclose any actual or potential conflicts of interest involving the respondent, its employees, and subcontractors that could compromise performance obligations under any resulting contract. The form requires completion of only one checkbox option: either disclosing specific conflict of interest information or certifying that no conflicts exist. Failure to complete, sign, and submit this form with the proposal may result in disqualification.
The document requires respondents to certify compliance with three specific Texas Government Code sections: Section 669.003 (restrictions on contracting with executive heads of state agencies), Section 572.069 (prohibiting employment of state officers and employees who participated in procurement), and Section 2252.901 (contracts with former or retired agency employees). If any of these statutes apply to the respondent, detailed information must be provided including the name of the former executive or employee, the state agency, date of separation, and date of employment with the respondent. The form establishes a continuing disclosure obligation requiring respondents to submit updated information if circumstances change or additional information becomes available after proposal submission. The authorized bidder representative must sign and date the form, providing their printed name.
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Text version
RFP No. 301-26-06531
EXHIBIT D
CONFLICT OF INTEREST
Disclosure
FAILURE TO COMPLETE, SIGN AND SUBMIT THIS EXECUTION OF PROPOSAL FORM
WITH RESPONDENT’S PROPOSAL MAY RESULT IN DISQUALIFICATION
RESPONDENT CONFLICT OF INTEREST DISCLOSURE AND CERTIFICATION
By signing this Conflict of Interest Disclosure and Certification, Respondent certifies and affirms the following:
1) Respondent has read and understands the various conflict of interests contract provisions, contract certifications, and conflict of interest statutes cited in the RFP, including, but not limited to, those contained in RFP Part B, Sections 14 (Prohibited Bids and Contracts), 16 (Gift to Public Servant), 21 (Conflicts of Interest; Disclosure of Conflicts; Disclosure of Interested Parties), and 54 (Compliance with Applicable Laws).
2) Except as otherwise disclosed in this Conflict of Interest Disclosure and Certification, Respondent, Respondents’ employees, and Respondents’ subcontractors do not have, nor shall they knowingly acquire, any interest that would create a conflict of interest, create the appearance of a conflict of interest, or be adverse to or conflict in any manner with the performance of Respondent’s obligations under any contract that may be awarded as a result of this RFP.
3) Complete only one the following check boxes as applicable:
Respondent discloses the following information that may present an actual or potential conflict of interest:
Respondent does not have any actual or potential conflicts of interest to disclose.
4) Respondent is compliant, and will remain in compliance during the term of any contract that may be awarded as the result of this RFP, with the following Sections of the Texas Government Code: Section 669.003 (Restriction on Contracting with Executive Head of State Agency); Section 572.069 (Prohibiting employment of state officers and employees who participated in the procurement of services); and Section 2252.901 (Contracts with Former or Retired Agency Employees). If any of these statutes apply, the Respondent shall complete the following information in order for its proposal to be evaluated:
Name of Former Executive or Employee: ____________________________________________________
Name of State Agency: ____________________________________________________
Date of separation from State Agency: ____________________________________________________
Date of employment with Respondent: ____________________________________________________
5) If the circumstances of the disclosures certified by Respondent change or additional information is obtained subsequent to the submission of Proposals, Respondent agrees that it is under a continuing duty to supplement its response under this provision, and Respondent shall submit updated information as soon as reasonably possible upon learning of any change to information contained in this disclosure and certification.
Signature - Authorized Bidder Representative
Printed Name Date
File details come from the government source that posted it. Updated .