ESBD_508959_1776889571682_Attachment C - Conflict of Interest Disclosure Statement.pdf
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- Attached to
- OER Grantee Technical Assistant Partner
- Solicitation number
- 781-6-CB-14
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Conflict of Interest Disclosure Statement attachment for RFP No. 781-6-CB-14 issued by the Texas Higher Education Coordinating Board (THECB). The document requires all respondents to disclose any existing or potential conflicts of interest and affirm their neutrality and impartiality in their proposals. Respondents must identify the extent, nature, and length of any relationships or engagements that could constitute a conflict of interest, with THECB serving as the sole arbiter in determining whether conflicts exist. The document specifies that failure to provide either a conflict of interest statement or a declaration that no conflicts exist will result in automatic disqualification of the respondent. Additionally, THECB cannot contract with individuals employed by the agency within the past twelve months, though those employed between twelve and twenty-four months prior must disclose the nature and end date of their previous employment.
The disclosure statement includes an unsworn declaration form that requires the authorized respondent representative to provide their name, date of birth, address, and signature under penalty of perjury. The form contains checkbox options to indicate either no conflicts or submission of conflict disclosures, with accompanying fields for recording conflict details including year, name, date of birth, street address, city, zip code, country, county, state, and date. The document also notes that THECB, as a state agency bound by the Texas Constitution, cannot indemnify respondents and discourages proposals from including indemnification terms, as such terms may render the proposal nonresponsive.
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Text version
ATTACHMENT C– CONFLICT OF INTEREST STATEMENT
RFP No. 781-6-CB-14
Respondents shall be neutral and impartial and shall not advocate specific positions to THECB. Respondents are encouraged to provide complete disclosure of matters that might be considered a conflict of interest. Completeness of disclosure may be a factor in evaluating proposals. Respondents shall identify the extent, nature, and length of any relationships or engagements that might be considered a conflict of interest. THECB will determine whether a conflict of interest or the perception of a conflict of interest exists from the perspective of a reasonable person uninvolved in the matters covered by the resulting contract. THECB is the sole arbiter of whether a conflict or the appearance of a conflict of interests exists. Entities having a conflict of interest, as determined by THECB, will not be eligible for contract award.
If a Respondent does not have any known or potential conflict of interest, the proposal should include such a statement. Failure to provide either a statement on potential conflicts of interest or a statement that no potential conflicts exist shall automatically disqualify the Respondent.
Respondents must address how they intend to ensure that no interest arising or potentially arising as a result of its activities or those of its parent, affiliate, or other related entity shall conflict with Respondent’s duty should it be selected to provide these services.
THECB may not enter into a contract with a person who has been employed by THECB within the past twelve months. Persons who have been employed by THECB or by another state agency in Texas more than twelve months but fewer than twenty-four months ago shall disclose in the proposal the nature of previous employment with the state agency and the date the employment ended.
NOTE: THECB, as a state agency, is prevented by the Texas Constitution from indemnifying Respondents. Respondents are discouraged from including a term in their Proposal that requires THECB to indemnify them. Such a term may result in the proposal being deemed nonresponsive.
Conflict of Interest Statement:
☐ I hereby affirm that Respondent has no known existing or potential conflicts of interest.
☐ Respondent submits the following conflict of interest statement:
UNSWORN DECLARATION:
“My name is _____________________________, my date of birth is _________, (Authorized Respondent Representative) and my address is ___________________, ________________, ___________, (Street) (City) (State)
___________ and _________________. I declare under penalty of perjury that the (Zip Code) (Country) foregoing is true and correct.
Executed in ______________ County, State of ________, on the ___ day of
____________ 202__.
_____________________________________, Declarant.”
(Signature of Authorized Respondent Representative)
| Check Box - No Conflicts: Off |
| Check Box - Submit Conflicts: Off |
| Conflcts of Interest: |
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| Name: |
| Date of Birth: |
| Street: |
| City: |
| Zip Code: |
| Country: |
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