Attach_4_-_NDA_ETM2.docx

FA702217QETM2

Attachment 4 Source Selection Non-Disclosure Agreement (NDA)

Name (print):

(or insert title of position, 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 (see note below) by Jody Desormeaux 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.

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.

Signature:

Date:

Debriefing Certificate

I have been debriefed orally by 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.

Signature:

Date: