4c-Attachmt3-Non-Disclosure-Form-.doc

RFQ: SBIC Examinations and Related Work

CONFLICT OF INTEREST AND NON-DISCLOSURE STATEMENT

I, _________________________________, certify that I will not discuss with, or reveal to, any representative of any business organization or other entity, or any individual person (except persons specifically assigned to my specific proposal evaluation group) either within or outside the United States Government, any aspects of the pending procurements under the Small Business Administration’s (SBA) Office of Investment and Innovation (OII) “SBIC Examinations and Related Work”. The term “any aspects of the pending procurement” includes, but is not limited to, information such as the identity and number of Contractors, the method of procurement, the number and identity of Government personnel involved, and the schedule of key technical and procurement events in the source selection process. Except as specifically authorized by the Contracting Officer (CO), the release of such information constitutes the unauthorized release of advance procurement or procurement information.

I recognize that a significant factor in the successful and proper completion of the source selection process is the strict confidentiality observed by all Government participants in the various proposal evaluation and evaluation review groups concerning all of the activities and procedures involved in source selection and that failure to comply with these requirements may compromise the ultimate source selection.

I acknowledge that the unauthorized release of advance procurement or procurement information as defined herein may result in the termination of my participation in this procurement. In the event I release any of the advance procurement or procurement information covered herein, I agree to so advise the senior member of the proposal evaluation or proposal evaluation review group to which I am assigned as soon as practicable. That notice will identify the business organization or other entity, or individual person, to whom the information in question was divulged and the content of that information.

I affirm that in the event that any business entity, either as a prime or subcontractor, in which I, or any member of my family or household, have holdings, financial interest, or an employment relationship, of whatever nature and to whatever extent, submits a proposal in response to this requirement that I will notify the CO in writing and withdraw from participation in the evaluation.

I affirm that if selected as Contractor I will not:

(1) possess a direct or indirect ownership interest in an SBIC which is the subject of an examination by the Contract (the subject SBIC);

(2) perform an examination if such examination would include reviewing documents of the subject SBIC prepared, drafted or commented on by Contractor (including, but not limited to, work-papers, SBA forms, regulatory filings, or other documents) or reviewing actions of the subject SBIC taken upon any advice rendered by Contractor in connection with any prior employment by the subject SBIC;

(3) advise or provide any professional services to the subject SBIC during the term of the examination and for a period of one year following the report date of the examination of such SBIC pursuant to this contract; and / or

(4) in the case of a Leveraged SBIC, be employed by, offer or negotiate employment with, or seek to be retained for professional services by the subject SBIC for one year following the report date of the examination of the subject SBIC pursuant to the contract.

I agree that, if selected as Contractor, I will provide to SBA a list of all SBIC contacts, clients, and customers for any audits, professional services, or any other work done for such parties within the last five years. The list shall include relevant names, dates, and details. The list shall include Affiliates as defined by SBA regulations. The list shall also include contacts, clients, and customers of Contractor’s employees and any Subcontractor’s employees.

I further agree that I will also provide an updated list every quarter while the contract is in effect, and for two years after the completion of the last task order issued pursuant to this contract.

Finally, I agree that if an SBIC or an Affiliate becomes a client, I will notify in writing the Director of the Office of SBIC examinations within 10 days of the client relationship being established. This notification requirement remains in effect for two years following the completion of this contract and all its task orders.

Printed Name: Date: _________________ Signature: _______________________________________________________________ Organization: ____________________________________________________________ Position Title: ___________________________________________________________

Confidentiality / Non-Disclosure Agreement – SBIC Examinations