NON-DISCLOSURE AGREEMENT AND CONFLICT OF INTEREST
STATEMENT FOR ______________________________
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Name: ___________________________________________________
Job Title: ____________________________ Organization: _______________
Project: _____________________________ Date: ______________
Acknowledgment of Obligations:
1. I acknowledge I have been assigned to the project/program indicated above (the
“project/program”).
2. I understand that I may be given access to information which is proprietary and/or
procurement sensitive, and belonging to the Defense Logistics Agency (DLA),
contractors or their suppliers. I have been briefed and am knowledgeable
regarding the requirement of Subsection 27(a) of the Office of Federal
Procurement Policy Act (also known as the Procurement Integrity Act), 41 U.S.C.
sections 2010-2017 and FAR 3.104 regarding unauthorized disclosure of
contractor bid and proposal information, as well as source selection information.
In addition, I understand that all information is for Government use only and may
be used only in the performance of work requirements necessary to carry out my
duties under this Project/Program. I also understand the requirements of Defense
Logistics Agency Instruction 6303, “For Official Use Only Material.”
3. I understand that unauthorized disclosure of confidential information as it relates
to this project/program could damage the integrity of this procurement and that
the transmission or revelation of such information to unauthorized persons could
subject me to prosecution under the Procurement Integrity Act, 41 U.S.C.
Sections 2010-2017 or under other applicable laws.
4. I do agree that I will not divulge, publish, or reveal by word, conduct, or any other
means, such information or knowledge, (including, but not limited to, the identity
or number of offers, the ratings used during the evaluation process, or the names
of any persons involved in the evaluation process) except as necessary to do so in
the performance of my official duties related to this project/program and in
accordance with U.S. laws, unless specifically authorized in writing by an
authorized representative of the United States Government.
5. I understand that the information I receive will be given only to persons
specifically granted access to the project information and may not be further
divulged without specific prior written approval from an authorized individual. I
also agree not to remove proposal or source selection documents (or any copies
thereof) from authorized locations without the express approval of the Contracting
Officer in charge of this project/program.
NON-DISCLOSURE AGREEMENT AND CONFLICT OF INTEREST
STATEMENT FOR ______________________________
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6. I also understand that I must comply with the obligations and requirements
contained in this Agreement at all times during the acquisition process and after
completion of the procurement as well.
7. I shall not engage in any personal, business, or professional activity or receive or
retain any direct or indirect financial interest, which places me in a position of
conflict between my private interest and my duties or responsibilities related to
this project/program. The private interest of my spouse, dependent children, or
any household members is considered as my private interest. If, at any time
during this project/program, my participation might result in a real, apparent,
possible, or potential conflict of interest, I will immediately report the
circumstances in writing to the Contracting Officer.
8. Note: A conflict of interest can be the result of a personal financial interest in any
of the business concerns involved in or interested in the project/program. The
term "financial interest" includes assets owned by you, your spouse, or your
dependent children such as stocks, bonds, pensions, loans, trust holdings,
IRA/401K holdings, salaries, fees, consulting arrangements or commissions.
“Financial interest” also includes: any position of employment with said business
concerns including positions of officer, director, trustee, employee, consultant,
partner or agency; and negotiations for such employment or positions.
9. I have read and understand the requirements of 5 C.F.R. Part 2635, Standards of
Ethical Conduct for Employees of the Executive Branch and/or DoD 5500.7-R,
Joint Ethics Regulation.
10. All personnel are requested to check the applicable block:
[ ] I have submitted a current OGE 450, Executive Branch Personnel Confidential
Financial Disclosure Report, or OGE 278, Executive Personnel Financial
Disclosure Report, as required by DODD 5500.7.
[ ] I will submit a OGE 450 or OGE 278 to the Contracting Officer within ten work
days from the date of endorsement of this Acknowledgment.
[ ] I am not required to submit a OGE 450 or OGE 278.
7. I take this obligation freely, without any mental reservation or purpose of evasion, in
the absence of duress. I acknowledge I am bound by the terms of this
Acknowledgment and applicable legal authorities.
Signature: ____________________________________ Date: ______________
