Attachment_D.pdf

Solicitation #: QTA0017AS4002 Concurrent Contract Operations

ATTACHMENT D

CERTIFICATION CONCERNING CONFLICT OF INTEREST

NAME: _____________________________

(Type or print)

Please sign, date, and return this certification to the Contracting Officer.

With respect to the Concurrent Contract Operations supporting EIS and Networx, I hereby certify that:

• I have read and understand 5 CFR 2635 (D, E and G) Standards of Ethical Conduct for Employees of the Executive Branch relating to conflicts of interest and apparent conflicts of interest.

• I am not aware of any other circumstances which would impair my exercise of independent judgment or my impartiality with respect to my duties in support of the above-cited acquisition.

• I understand that in the performance of this task order, there is the potential that I will be exposed to information that might result in a Conflict of Interest (COI) that could limit the ability _________ (contractor) and/or its subcontractors to compete in future acquisitions for support in EIS and Networx operations. I agree that I will immediately notify the _________ (contractor) Program Manager, the GSA Contracting Officer (CO), and the GSA Contracting Officer’ s Representative (COR) of any situation or information that might result in a potential COI. In the event that a COI is identified, GSA and __________ (contractor) will institute a COI mitigation plan, limit access to information that might cause a COI, or take other measures to ensure that no COI exists.

• All work, including all market research or acquisition support components of this contract, shall be conducted in such a way that no contractor or other outside entity will have any competitive advantage on a potential future solicitation due to the market research or business operations support performed and/or information provided.

• I understand that I have a continuing obligation to disclose any circumstances that may create an actual or apparent conflict of interest. In the event that I become aware of any such conflict of interest, I agree to immediately report this fact to the Concurrent Contract Operations COR and CO and take no further action concerning the procurement pending receipt of any instructions which he or she may give me in this matter.

Solicitation #: QTA0017AS4002 Concurrent Contract Operations

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