ESBD_568865_1792163438301_RFP 301-27-08828 Exhibit D - Conflict of Interest Disclosure.pdf
PDF 598 KB Posted
- Solicitation number
- RFP-301-27-08828
- Issued by
- Texas
About this file
This is a Conflict of Interest Disclosure and Certification form (Exhibit D) for RFP No. 301-27-08828, issued by the State of Texas for the 2027 Texas Women's Leadership Conference Audio Visual Services and Support contract opportunity. The form is a mandatory submission requirement that must be completed, signed, and submitted with the respondent's proposal; failure to do so may result in disqualification. Respondents must certify that they have read and understand all conflict of interest provisions, contract certifications, and relevant statutes referenced in RFP Part B, including Sections 14, 16, 21, and 54, and that neither they, their employees, nor their subcontractors have any interests that would create an actual or potential conflict of interest or adversely affect contract performance.
Respondents must indicate whether they have any actual or potential conflicts of interest to disclose or certify that no such conflicts exist. If applicable, respondents must provide specific information regarding employment of former state executives or employees, including the employee's name, the relevant state agency, date of separation, and date of employment with the respondent. Respondents must also affirm compliance with Texas Government Code Sections 669.003, 572.069, and 2252.901, which address restrictions on contracting with executive heads of state agencies, prohibitions on employment of state officers and employees involved in procurement, and regulations on contracts with former or retired agency employees. Respondents are placed under a continuing duty to supplement disclosures and report any changes to the disclosed information as soon as reasonably possible after submission of their proposals.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP No. 301-27-08828
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 .