A23 Attachment 2 NDA and COI Form.docx

ADAP FORM 209-506-7 SOURCE SELECTION NON-DISCLOSURE AGREEMENT

AND CONFLICT OF INTEREST FORM (MAY 2025)

(Return to the Contracting Officer)

SUBJ: Solicitation / Contract #_____________________

Encl: List of firms, including the potential or actual offerors, team members, and subcontractors

AGREEMENT

1. This Agreement applies to Government personnel participating on the Source Selection Team for subject Solicitation / Contract (“Acquisition”).

2. This Agreement contains the rules relating to this Acquisition regarding conflicts of interest and safeguarding confidential and proprietary source selection information.

3. Your signature on this Agreement indicates that you have read and understand this Agreement and voluntarily agree to be bound by its terms and that you understand that failure to comply with the requirements may compromise the evaluation and may violate law and regulation. Thus, you understand that you may be subject to disciplinary administrative action and/or referred for civil action or criminal prosecution.

TERMS

4. I have read, understand, and will abide by the requirements of Section 27 of the Office of Federal Procurement Policy Act (41 U.S.C. § 423), as implemented in the Federal Acquisition Regulation (FAR) 3.104, “Procurement Integrity.” I also have read, understand, and will abide by the requirements of 41 U.S.C. §§ 2101 - 2107 and FAR 15.207, which impose safeguards on the handling of this material and restrictions on the release or disclosure of contractor bid or proposal and source selection information. I also certify that I have read, understand, and will abide by the provisions in FAR 3.104-3, entitled "Statutory and related prohibitions, restrictions, and requirements" and FAR 3.104-4, entitled "Disclosure, protection, and marking of contractor bid or proposal information and source selection information." Thus, I certify that I will not disclose to any person or entity any information I receive or am exposed to as I participate on the evaluation and source selection process for this Acquisition.

5. I recognize that a significant factor in the successful and proper completion of the evaluation and source selection process is the strict confidentiality observed by all Government personnel participating in the evaluation and source selection process during the various proposal evaluation reviews and advisory staff meetings concerning all of the activities and procedures involved in the evaluation and source selection process.

6. I understand that all communications associated with this Acquisition with any of the offerors submitting proposals in response to this Acquisition or their proposed team members, affiliates, subcontractors, or consultants must be made by and through the Contracting Officer. I will refrain from any communications with any of the offerors submitting proposals in response to this Acquisition or their proposed team members, affiliates, subcontractors, or consultants, and I will divert all attempted communications by offerors’ representatives or any other unauthorized person to the Contracting Officer.

7. I will not discuss any matter related to evaluation or source selection for this Acquisition, including proprietary proposal information, with any unauthorized individuals (including other Government personnel), even after award, unless authorized to do so by proper authority. All discussions of evaluation and source selection matters with other Source Selection Evaluation Board members shall be conducted solely in those areas designated for such deliberations.

8. I will instruct members of my parent or home agency/organization not to divulge my participation in the evaluation and source selection process or my physical location while participating in the evaluation to unauthorized persons.

9. I realize that my actions in connection with my participation in this source selection process are subject to intense scrutiny, and I will conduct myself in a way that will not adversely affect the confidence of the public in the source selection process. I will avoid any action, whether or not prohibited, that could result in or create the appearance of my losing independence or impartiality. I will not use my public office for private gain, and I agree not to engage in any personal business or professional activity, or to enter into any financial transaction, that involves or appears to involve the direct or indirect use of “inside information” to further the private gain for myself or others.

10. I understand that my obligations under this certification are of a continuing nature, and, if anything takes place which would cause a change to any statement or create a violation of any representation or rule of conduct herein, I will immediately bring such matter to the attention of the Chairperson of the Source Selection Evaluation Board or the Contracting Officer and legal counsel.

11. I understand my obligation not to disclose information includes: (1) information on the number of quotes received from offerors; (2) information on the quotes received from offerors; (3) the methods or procedures being used to evaluate quotes; (4) the substance of any discussions with any offerors; (5) the standards, ratings, or scores used in the evaluation process; and (6) any award decision of the Source Selection Evaluation Board unless and until such decision is publicly announced.

12. I will not disclose any information learned through my participation in this procurement to any offeror or prospective offeror for any follow-on requirements related to this procurement.

13. I will not ask for, demand, exact, solicit, seek, accept, receive, or agree to receive, directly or indirectly, any money, gratuity, or other thing of value from any of the offerors submitting proposals in response to this Acquisition or their proposed team members, affiliates, subcontractors, or consultants. I will advise all persons whose financial interest is imputed to me that the acceptance of a gratuity from those who are engaged in or seek to do business with the Department of Defense must be avoided. I will not solicit or accept, directly or indirectly, any promise of future employment or business opportunity from, or engage, directly or indirectly, in any discussion of future employment or business opportunity with any of the offerors submitting proposals in response to this Acquisition or their proposed team members, affiliates, subcontractors, or consultants.

15a. In accordance with 5 C.F.R. Part 2640, I certify neither I, my spouse, my dependent child(ren), members of my household, nor anyone whose financial interest is imputed to me possess any direct or indirect financial interest* in any of the offerors submitting proposals in response to this Acquisition or their proposed team members, affiliates, subcontractors, or consultants (including, but not limited to, parent companies, subsidiaries, sister companies, etc.) listed in the Enclosure. Further, I certify that neither I, my spouse, my dependent child(ren), members of my household, nor anyone whose financial interest is imputed to me currently work for, or are currently seeking employment from, any of the companies or their affiliates (including, but not limited to, parent companies, subsidiaries, sister companies, etc.) listed in the Enclosure.

15b. To the best of my knowledge, neither I, my spouse, my dependent child(ren), members of my household, nor anyone whose financial interest is imputed to me have any direct or indirect financial interest in the firms listed in the Enclosure, except:

*Direct or indirect financial interest includes any current or contingent ownership, equity, or security interest in real or personal property or a business entity and may include indebtedness or compensated employment relationship. It includes, for example, financial interests in the nature of stocks, bonds, partnership interests, fee and leasehold interests, mineral and other property rights, deeds of trust, and liens, and extends to any right to purchase or acquire any such interest, such as a stock option or commodity future. The term financial interest also includes service, with or without compensation, as an officer, director, trustee, general partner, or employee of any person, including a nonprofit entity, whose financial interests are imputed to the employee under 5 C.F.R. § 2635.402(b)(2)(iii) or (iv).

Immediately upon recognizing any direct or indirect financial interest, I shall notify the Contracting Officer and I will not continue my participation unless authorized to do so in accordance with applicable law.

16. To the best of my knowledge, and after diligent inquiry, no person whose financial interest is imputed to me has a direct or indirect financial interest in the firms listed in the Enclosure, except:

NOTE: The information provided under Paragraph 16 does not automatically result in the Government personnel being deemed unable to participate in the acquisition/source selection process. The effect of the information provided under Paragraph 6 will be determined by the Contracting Officer, who may consult with legal counsel.

**** 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 whistleblower 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. ****

CERTIFICATION

I voluntarily agree to the terms of this Agreement and certify that I have read and understand my obligations. I further certify that the statements made herein are true and correct.

If I do not understand any portion of this Agreement or the above-mentioned Federal law and FAR provisions, I understand it is my obligation to seek clarification from the Contracting Officer and/or legal counsel.

Name (Printed)

Agency/Organization (Printed)

Date: Signature

SOURCE SELECTION INFORMATION

SEE FAR 3.104

SOURCE SELECTION INFORMATION

SEE FAR 3.104