Certification Regarding Confidentiality and Disclosure of Conflict of Interest (COI)

All individuals who participate in an evaluation committee shall use this form prior to review of any proposals to: (a) indicate their understanding and agreement with the [enter project name] policy regarding the confidentiality of proposals and use of the information contained therein, and (b) certify that they do not have family, business, or financial relationships that could interfere with his or her objectivity in evaluating proposals.

With respect to all proposals submitted in response to [state "Request for Proposals (RFP)" or "Request for Quotations (RFQ)"] No. [enter RFP or RFQ #] for the [enter project name] Project, the undersigned hereby agrees and certifies to the following:

  1. 1. I will adhere to PRF’s Standards of Conduct or Ethics.
  2. 2. I will use the proposal(s) and all the information therein for evaluation purposes only. I will safeguard the proposal(s) and will not disclose them, or any information contained in them (other than information publicly available without restriction), except as directed or approved by the [Executive Director] of the [enter project name] Project.
  3. 3. I have carefully reviewed my employment (past, present, and under consideration) and financial interests, as well as those of my family members. Based on this review, I certify, to the best of my knowledge and belief as of the date indicated below, that either (a) I have no actual or potential relationships that would pose a conflict of interest and thus could diminish my capacity to perform an impartial and objective evaluation of the proposals, or that might otherwise result in an unfair competitive advantage to one or more prospective offerors, contractors, subcontractors, or suppliers; or (b) I have fully disclosed all such conflicts to the Executive Director of the [enter project name] Project and will comply fully with any instructions by the Executive Director (or their designee) to avoid, neutralize, or manage such conflicts. I understand I have a continuing obligation to disclose potential conflicts discovered at any time prior to the completion of the evaluation and to act as instructed.
  4. 4. Upon completing the evaluation, I will return all copies of the proposals, and any notes, details, and abstracts thereof, to the [enter project name] office that initially furnished them to me.
  5. 5. Unless authorized by the Executive Director of the [enter project name] Project in advance and in writing I will not — whether before, during, or after the evaluation — contact any prospective offeror, subcontractor, vendor, supplier, or its employees, representatives, or agents concerning any aspect of the proposal.
  6. 6. Project and employees may not ask for or accept (and potential subcontractors and suppliers are prohibited from offering) any money, fee, commission, credit, gift, gratuity, object of value, or compensation to improperly obtain or reward favorable treatment in connection with any evaluation process or award. I will immediately report any improper request or offer from any potential subcontractor or supplier to the Executive Director.

Signature: ___________________________

Printed Name: ___________________________

Title: ___________________________

Date: ___________________________

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