Fillable NDA for Source Selection.pdf

BLANKET NON-DISCLOSURE AGREEMENT AND CONFLICT OF INTEREST

STATEMENT FOR SOURCE SELECTION PARTICIPATION

IMPORTANT: This agreement concerns a matter within the jurisdiction of a United States Government Agency. Any false, fictitious, or fraudulent statements and/or certifications made in or in relationship to this agreement may be subject to prosecution under 18 U.S.C. § 1001.

NAME: _________________________________________

a. This agreement applies to individuals that are repeatedly involved in procurement source selections. This agreement applies to your official duties as a [fill in your role in the procurement, e.g., reviewing HQ procurement analyst; Head of the Contracting Activity; or reviewing Counsel.] This agreement is effective for ONE YEAR from the date of your signature.

b. This agreement contains the rules of conduct for the acquisitions participated in as part of your official duties. It includes rules of conduct regarding conflicts of interest and the safeguarding of confidential information.

c. These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by existing statute or Executive Order 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.

d. Your signature on this agreement indicates that you have read this agreement and agree to be bound by its terms.

e. Your signature further indicates your knowledge of applicable portions of 41 U.S.C. Chapter 21 – Prohibitions on Disclosing and Obtaining Procurement Information; Federal Acquisition Regulation, FAR 3.104 regarding unauthorized disclosure of contractor bid and proposal information and source selection information; and 5 C.F.R. 2635 – Standards of Ethical Conducts for Employees of the Executive Branch, regarding applicable standards of conduct (including procedures to prevent the improper disclosure of information).

CONFLICTS OF INTEREST

a. Check the applicable block:

I have submitted a current OGE Form 450, Executive Branch Personnel Confidential Financial Disclosure Report, as required by Dodd 5500.07, Standards of Conduct.

I am not required to submit an OGE Form 450.

I have submitted a current SF278, Public Financial Disclosure Report, as required by DoDD 5500.07, Standards of Conduct.

I am not required to submit a Form SF278 or

I am a non-Government employee. I have signed a proprietary information non-disclosure agreement that has been included in the contract between my firm and the Government that precludes me from divulging any protected information and proprietary data to which I may gain access during the evaluation of proposals.

b. By signing the agreement you certify that, to the best of your knowledge, neither you nor anyone in your family, your general partner, nor organization in which you serve as officer, director, trustee, general partner or employee, or any person or organization with whom you are negotiating or have any arrangement concerning prospective employment, have any direct or indirect financial interest or any other beneficial interest:

(1) In any firm on the list of potential offers or of those which have otherwise expressed an interest in the acquisition (if this certification is made prior to receipt/opening of proposals).

(2) In any of the firms submitting proposals in response to solicitations received/reviewed or their proposed subcontractors (if this certification is made subsequent to receipt/opening of proposals).

Should any company in which you or your immediate family have a financial interest submit a bid/offer/proposal, you will immediately reveal such interest to the Source Selection Evaluation Board (SSEB) Chairperson (or similar source selection authority) and the Contracting Officer.

A financial interest valued at less than $15,000 is not disqualifying and need not be reported on this form. This $15,000 value is additive among you, your spouse, and minor children, if any.

c. By signing this agreement, you further acknowledge your obligation to disclose any friendships; family or social relationships; past, present or planned employment relationships; or any other type of relationship, such as housing or transportation arrangements, which might be perceived as compromising your independent judgment in connection with Source Selections participated with under the terms of this blanket agreement.

PROTECTING CONFIDENTIAL INFORMATION

By signing this agreement, you agree not to disclose confidential, proprietary, and/or source-selection-sensitive information to any individual or entity, unless that individual or entity is authorized by the Contracting Officer to receive such information. This means that you:

a. Agree to abide by the terms of FAR Part 3.104;

b. Will not knowingly disclose, directly or indirectly, proprietary or source selection sensitive information to any individual or entity not participating in source selections covered by this agreement, unless that individual or entity is authorized by Defense Logistics Acquisition Directive (DLAD) 3.104-4 or the Contracting Officer to access such information;

c. Understand that all communications with offerors or their subcontractors concerning this acquisition must be made by/through the Contracting Officer or his/ her designee. Should any offer or any offeror’s subcontractor initiate any contact, you will not make any response other than to refer the person initiating contact to the Contracting Officer and you will report all attempted communications by the offeror’s representatives or any other unauthorized person to the Contracting Officer, and advise the official who appointed you to participate in the source selection of such attempts;

d. Agree not to discuss evaluation or source selection matters (including proprietary proposal information) with any unauthorized individuals (including private sector and Government personnel who have not signed nondisclosure agreements), even after the announcement of the successful contractor(s), unless authorized by the Contracting Officer. Discussion of the evaluation/source selection matters with other source selection members should be conducted in areas designated for secured deliberations; and

e. Acknowledge that disclosure of proprietary information may violate the Trade Secrets Act (18 U.S.C. § 1905) and the Procurement Integrity Act (41 U.S.C. Chapter 21; as implemented in FAR 3.104). If you are found to have violated the Trade Secrets Act or the Procurement Integrity Act, you may be subject to criminal penalties and administrative penalties, including and up to termination of your employment.

OTHER STANDARDS OF CONDUCT

By signing this agreement you agree to abide by the following additional rules of conduct for any procurement action requiring your participation:

a. You agree not to communicate with offerors or their subcontractors concerning this acquisition unless you first obtain the approval of the Contracting Officer.

b. You recognize that your participation in source selections may be subject to scrutiny. As such, you agree to conduct yourself in such a way as to not adversely affect the confidence of the public or competing contractors in the source selection process. You will not use your public office or company position for private gain, and you agree not to engage in any personal business or professional activity, or enter into any financial transaction, that involves or appears to involve the direct or indirect use of non-public information to further a private gain for yourself or others.

c. You agree to avoid any action, whether or not prohibited, that could result in, or could create, the appearance of or lack of independence or a lack of impartiality.

CONTINUING RESPONSIBILITY

You understand that your obligations under this agreement are of a continuing nature. If anything takes place that would cause a change to any statement or create a violation of any representation or rule of conduct contained in this agreement, you agree to inform the Contracting Officer promptly.

I am involved in the review of various procurements on a repeated basis. For all such procurements I acknowledge I am bound by the terms of this Agreement and applicable legal authorities.

Signature: __________________________ Date: ________________

Job Title: ______________________________________________ Organization: _________

Contracting Officer Signature : ______________________________Date:________________