Attch_19_NDA_Amendment_01_COM-F_III.pdf

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

Source Selection Non-Disclosure Agreement (NDA) Page of ( Insert position title if this form is used as an annual NDA IAW AFFARS 5303.104-4. )

1. I acknowledge I have been assigned to the source selection indicated above. I have been briefed orally by the individual indicated below and, as such, am knowledgeable of 41 U.S.C. 2101-2107 and FAR 3.104. I am aware that unauthorized disclosure of contractor bid or proposal information or source selection information could damage the integrity of this procurement and that the transmission or revelation of such information to unauthorized persons could subject me to prosecution under 41 U.S.C. 2101-2107 or under other applicable laws.

( NOTE: Oral briefing is not required for annual filers. )

2. I do solemnly swear or affirm that I will not divulge, publish, or reveal by word, conduct, or any other means, such information or knowledge, except as necessary to do so in the performance of my official duties related to this source selection and in accordance with the laws of the United States, unless specifically authorized in writing in each and every case by a duly authorized representative of the United States Government. I take this obligation freely, without any mental reservation or purpose of evasion and in the absence of duress. "These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by existing statute or Executive order relating to (1) classified information, (2) communications to Congress, (3) the reporting to an Inspector General of a violation of any law, rule, or regulation, or mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety, or (4) any other whistle blower protection. The definitions, requirements, obligations, rights, sanctions, and liabilities created by controlling Executive orders and statutory provisions are incorporated into this agreement and are controlling." 5 USC 2302(b)(13).

3. I acknowledge that the information I receive will be given only to persons specifically granted access to the source selection information and may not be further divulged without specific prior written approval from an authorized individual.

4. If, at any time during the source selection process, my participation might result in a real, apparent, possible, or potential conflict of interest, I will immediately report the circumstances to the Source Selection Authority.

5. All personnel are requested to check the applicable block(s):

I have submitted a current OGE Form 450, Executive Branch Confidential Financial Disclosure Report, as required by DoDD 5500.07, Standards of Conduct.

I am not required to submit an OGE Form 450.

I have submitted a current OGE Form 278, Public Financial Disclosure Report, as required by DoDD 5500.07, Standards of Conduct.

I am not required to submit an OGE Form 278.

I am a non-government employee. I have signed a proprietary information non-disclosure agreement that has been included in the contract between my firm and the government that precludes me from divulging any proprietary data to which I may gain access during the source selection. I have submitted (or will submit) a Conflict of Interest Statement and documentation to the Contracting Officer indicating my personal stock holdings prior to accessing source selection information.

Debriefing Certificate I have been debriefed orally by the individual indicated below as to my obligation to protect all information to which I have had access during this source selection. I no longer have any material pertinent to this source selection in my possession except material that I have been authorized in writing to retain by the Source Selection Authority. I will not discuss, communicate, transmit, or release any information orally, in writing, or by any other means to anyone after this date unless specifically authorized to do so by a duly authorized representative of the United States Government.

9.0.0.2.20120627.2.874785