ORGANIZATIONALCONFLICTSOFINTEREST.doc

FDA Consolidation at White Oak - OC/ORA Office Building Solicitation GS-11P07MKC0070 Neg.

ORGANIZATIONAL CONFLICTS OF INTEREST DISCLOSURE CERTIFICATE

In accordance with the requirements of FAR Subpart 9.5—Organizational and Consultant Conflicts of Interest and Organizational Conflicts of Interest Disclosure Provision (06/07), as a condition of award of a contract, the apparent successful offeror submits to the Contracting Officer the certificate below:

Solicitation No. GS11P08MKC0013 for the NE Parking Gargage, Food and Drug Administration - White Oak, Silver Spring, Maryland

1.

Apparent Successful Offeror Name:

Address:

Telephone No.:

Federal TIN:

2. Please list below (or use additional paper if necessary), the name, address, telephone number of the client(s), a description of the services rendered to the previous client(s), and the name of a responsible officer/employee of the offeror who is knowledgeable about the services rendered to each client if, in the 12 months preceding the date of the statement, services were rendered to the Government respecting the same subject matter of the instant solicitation, or directly relating to such subject matter. [Please list the agency and contract number, if applicable.]

3. The individual signing this certificate below certifies that to the best of his/her knowledge and belief, no actual or potential conflict of interest or unfair competitive advantage exists with respect to the construction services to be provided in connection with the instant contract, or that any actual or potential conflict of interest or unfair competitive advantage that does exist with respect to the contract in question has been communicated in writing to the contracting officer or his or her representative.

Name and Title

Signature of Authorized Representative Date

III-J-1