J.4 CONFLICT OF INTEREST AND NONDISCLOSURE AGREEMENT FORM.docx

DOE-HANFORD (DOE)

CONFLICT OF INTEREST AND NONDISCLOSURE AGREEMENT

In anticipation of my participating in providing services for the Department of Energy (DOE), under Solicitation # 89303923REM000008, (the Contractor), [Fill in Job Title/Category, in support of the DOE-ONE HANFORD, I agree to the following:

(Print Name of employee/subcontractor)

(a) I have read, and am familiar with, the restrictions regarding organizational and consultant conflicts of interest set forth in FAR Subpart 9.5 and DEAR 952.209-72;

(b) To the best of my knowledge and belief, I have no known conflict of interest, such as those described in DEAR 952.209-8(c), that may either:

(1) Result in my participation in providing Services for DOE which will have a direct and predictable effect upon my financial interest;

(2) Diminish my capacity to impartially assist in providing Services for DOE; or

(3) Result in a biased opinion or unfair advantage.

(c) In making the above statement, I have considered all the following factors that might place me in a position of conflict, real or apparent, in providing Services for DOE:

(1) All my stocks, bonds, other outstanding financial interests or commitments;

(2) All my employment arrangements (past, present, and under consideration);

(3) All financial interests and employment arrangements of my spouse, minor children, and other members of my immediate household; and

(4) All other external relationships and social networks.

(d) I have a continuing obligation to disclose any circumstance that may create an actual or apparent conflict of interest. If I learn of any such conflict, I am required to report it immediately to the DOE Project Manager, who will, in turn, appropriately advise the DOE Contracting Officer and/or his or her designated representative, and perform no further duties related to providing services under the above referenced contract until I receive updated instructions on the matter.

(e) I shall 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 officer, employee, representative, agent, or consultant of any person, firms, or entities that may potentially or actually submit a proposal in response to any requests for proposals issued by DOE for work to be performed at my place of work, including the Hanford Site. I will advise my family that the acceptance of any such gratuity may be imputed to me as a violation of my obligations under this agreement.

(f) I understand that during the course of performance under this contract I may obtain access to confidential or proprietary business, technical, or financial information belonging to the Government or other entities, including but not limited to DOE plans, policies, reports, studies, financial plans, internal data protected by the Privacy Act of 1974 (5 U.S.C. 552a), and data which has not been released or otherwise made available to the public (hereinafter referred to as "Confidential or Proprietary Information");

(g) For purposes of protecting Confidential or Proprietary Information, I am expected to treat this information as proprietary and confidential and am to comply with agency procedures for the protection of such information (including electronic information). I am to use my best efforts to safeguard such information. I understand that the requirement to protect Confidential or Proprietary Information does not stop after my contract with the Contractor terminates or is completed. I am further expected not to disclose the contents of, nor release, any such information to anyone during or after the period of performance of the General Support Services Contract for DOE, other than:

(1) Individuals within my organization that are directly concerned with the performance of this contract and who have executed this Conflict of Interest and Nondisclosure Agreement;

(2) Other individuals designated by the DOE Contracting Officer; or

(3) Pursuant to direction or an order from a court or federal office (e.g., the Government Accountability Office) of competent jurisdiction.

(h) I am expected to use Confidential or Proprietary Information in accordance with the task or subtask assignment only. I will report within one business day any unauthorized disclosure, whether intentional, unintentional, or suspected, to my DOE Program Manager and the DOE Contracting Officer. I understand that any authorized restriction on disclosure placed on the information by the submitters or the Government applies to any reproduction or abstracted information thereof.

(i) Whenever DOE furnishes any Confidential or Proprietary Information, I, the recipient, am expected to use such information only for the purposes stated in a task or subtask assignment and to treat the information obtained in confidence. This includes not sharing Confidential or Proprietary Information outside the government, with other Federal Agencies or with other DOE organizations except as outlined in (g) above. Further, I will not use such information for my own private gain or the private gain of others. This requirement for confidential treatment applies to information obtained from any source, including the submitter, without restriction. Any notice of restriction placed on such information by either DOE or the originator of the information shall be conspicuously affixed to any reproduction or abstract thereof and its provisions strictly complied with. Upon completion of my duties, I am expected to return all copies of Confidential or Proprietary Information to the DOE office that initially furnished such information.

(j) Whistleblower Protection. I understand these provisions are consistent with and do not supersede, conflict with, or otherwise alter my protections, rights and obligations created by The Atomic Energy Act of 1954 (42 U.S.C. 2011 et seq.) and the Energy Reorganization Act (ERA) 42 USC Section 585 as amended by the Energy Policy Act of 2005 (Pub. L. No. 109-58) relating to: (1) the reporting 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 to an Inspector General; the Government Accountability Office; the Contracting Officer; authorized law enforcement; a court or grand jury; or a responsible management official of DOE who has the responsibility to investigate, discover or address misconduct; (2) communications to Congress, or (3) any other whistleblower protection. The definitions, requirements, obligations, rights, sanctions, and liabilities created by the referenced statutory provisions are incorporated into this agreement and are controlling.

Signature/Date:

Print Name:

(Contractor Name ) (the Contractor) has reviewed the contents of this document and concurs.

The Contractor understands that it may seek any of the information discussed above from its employee/subcontractor and further agrees it shall report any breach of this agreement to the DOE Contracting Officer.

The undersigned hereby certifies to being an authorized official of the Contractor, authorized to sign for and bind the Contractor to this agreement.

Signature _____________________________________Date: ___________

Print Name: ___________________________________

Title: _____________________________________________ Authorized Official signing on behalf of (Contractor Name)