J-3 - Non-Disclosure Agreement.pdf

FOR OFFICIAL USE ONLY

NON-DISCLOSURE AGREEMENT

Name: Grade: ____ Job Title: Organization:

Title of Source Selection:

Briefing Acknowledgment

1. I acknowledge I have been assigned to assist USDA Rural Development to Business Support

Services for the Rural eConnectivity (Reconnect) Program under Contract number _______________. I am aware that unauthorized disclosure of any information assigned 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 the Procurement Integrity Laws or under other applicable laws.

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 assignment 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 any information and may not be further divulged without specific prior written approval from the Contracting Officer Representative (COR) of Record, Douglas Long.

4. If, at any time during the assignment, my participation might result in a real, apparent, possible, or potential conflict of interest, I will immediately report the circumstances to the Contracting Officer Representative (COR) of Record, Douglas Long.

5. Signing this Agreement does not bar disclosures to Congress or to an authorized official of an executive agency or the Department of Justice that are essential to reporting a substantial violation of law and this Agreement does not prohibit disclosures which are required under order of a court of competent jurisdiction. These provisions are consistent with and do not supersede, conflict with, or otherwise alter the obligations, rights, or liabilities created by existing statutes or Executive orders 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. These controlling Executive orders and statutory provisions include Executive Order No. 12958, as amended; Section 7211 of Title 5, United States Code (governing disclosures to Congress); Section 2302(b)(8) of Title 5, United States Code, as amended by the Whistleblower Protection Act (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the Intelligence Identities Protection Act of

1982 (50 USC 3121 et seq.) (governing disclosures that could expose confidential Government agents); and the statutes which protect against disclosure that may compromise the national security, including Sections 641, 793, 794, 798, and 952 of Title 18, United States Code, and Section 4(b) of the Subversive Activities Act of 1950 (50 USC 783(b)).

6. All personnel are requested to check the applicable block:

☐ I have submitted a current OGE Form 450, Confidential Financial Disclosure Report, as required by the Standards of Conduct.

☐ I am not required to submit an OGE Form 450.

☐ I have submitted a current OGE Form 278e, Executive Branch Personnel Public Financial

Disclosure Report, as required by the Standards of Conduct.

☐ I am not required to submit an OGE Form 278e.

☐ I am a non-Government employee. I have submitted a current OGE Form 450, Confidential Financial Disclosure Report, and I have signed or will sign a non-disclosure agreement that has been or will be included in the solicitation for each offeror to sign and submit with its proposal, which precludes me from divulging any source selection sensitive, proposal, or proprietary information to which I may gain access during the source selection process.

To the best of my knowledge, neither I, nor anyone in my immediate family, have any financial interest which may be affected by the outcome of this assignment. I understand that I have an ongoing duty to disclose any financial interest in any company involved in this procurement as either a prime contractor or a subcontractor which may be affected by the outcome of this Business Support Services for the Rural eConnectivity (Reconnect) Program assignment.

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 Business Support Services for the Rural eConnectivity (Reconnect) Program assignment. I no longer have any sensitive or proprietary material pertinent to this source selection in my possession except material that I have been authorized in writing to retain by the Contracting Officer Representative (COR) of Record, Douglas Long.

I will not discuss, communicate, transmit, or release any source selection or proposal 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: