ORGANIZATION_CONFLICT_OF_INTEREST_AGREEMENT.DOC

Attachment 1

ORGANIZATIONAL CONFLICTS OF INTEREST, CONFIDENTIALITY & NONDISCLOSURE AGREEMENT

Reference BPA No:

Requisition No:

Organization Name: __________________________________________________

Task Order Subject: __________________________________________________

(a) I certify that to the best of my knowledge and belief, there are no relevant facts or circumstances that could give rise to an organizational conflict of interest, as defined in FAR Subpart 9.5, or that the organization has disclosed all such relevant information.

(b) Prior to commencement of any work, I shall notify the Contracting Officer that to the best of my knowledge and belief, no actual or potential conflict of interest exists or identify any actual or potential conflict of interest the organization may have.

(c) As Contractor, I agree that if an actual or potential organizational conflict of interest is identified during performance, I will immediately make a full disclosure in writing to the Contracting Officer. This disclosure shall include a description of actions that the organization has taken or proposes to take, after consultation with the Contracting Officer, to avoid, mitigate, or neutralize the actual or potential conflict of interest. The organization shall continue performance until notified by the Contracting Officer of any contrary action to be taken.

(d) As Contractor, I recognize that organizational employees in performance of this contract may have access to data or other information, provided in the submission or during the contract performance, or generated during contract performance. Such information is confidential and cannot be released to the public or used for any private purpose without Risk Management Agency approval.

I understand that making a false, fictitious, or fraudulent certification may subject me to criminal prosecution under Title 18, United States Code, Section 1001.

Signature: _____________________________

Date: _______________

Printed Name: _____________________________________

Title:

Organization:

Organizational Conflicts Of Interest & Confidentiality Agreement