Corporate NDA/COI Form for Contractor Personnel

Corporate NDA/COI Form for Contractor Personnel

Certification Regarding Nondisclosure of Acquisition Information

MEMORANDUM FOR: ______

(Enter Name of User)

FROM: Eveth Mohamed

GSA WITS 3 Contracting Officer

SUBJECT:Certification Regarding Nondisclosure of Acquisition Information for theWITS Program

The proper custody, use, and preservation of official information related to procurements (validation, evaluation, negotiations, selection proceedings, etc.) cannot be overemphasized. It is essential that all personnel associated with acquisitions strictly comply with the applicable provisions of the laws and regulations. For reasons which include the foregoing, it is required that you execute the following certification. The original must be returned to me; the copy may be retained for your records.

With respect to the WITSProgram,I hereby certify that:

1. I have read and understand the pertinent GSA Standards of Conduct (41 CFR 105735) relating to the disclosure and misuse of official information.
2. I am familiar with the requirements of 18 U.S.C. 1905 which provides:

"Whoever, being an officer or employee of the United States or any department or agency thereof, or agent of the Department of Justice as defined in the Antitrust Civil Process Act (15 U.S.C. 13111314), publishes, divulges, discloses, or makes known in any manner or to any extent not authorized by law any information coming to him in the course of his employment or official duties or by reason of any examination or investigation made by, or return, report or record made to or filed with, such department or agency or officer or employee thereof, which information concerns or relates to the trade secrets, processes, operations, style of work, or apparatus, or to the identity, confidential statistical data, amount or source of any income, profits, losses, or expenditures of any person,

firm, partnership, corporation, or association; or permits any income return or copy thereof or any book containing any abstract or particulars thereof to be seen or examined by any person except as provided by law; shall be fined not more than $1,000, or imprisoned not more than one year, or both; and shall be removed from office or employment."

1. I understand that, unless otherwise authorized, the release of information concerning the above-cited acquisition shall be at the sole discretion and direction of the Contracting Officer, consistent with applicable laws and regulations.
2. Unless otherwise authorized by the Contracting Officer orappropriate legal authority, I shall not disclose or reveal any information to anyone not also designated as a participant in the abovecited acquisition (and then only on a need to know basis) which:

a)Would provide undue or discriminatory advantage to an offeror or other private interest (including information contained in vendor proposals and the identity or number of offerors).

b)Is or reflects confidential commercial information submitted by an offeror or which could reasonably be expected to cause competitive harm to an offeror.

c)Is otherwise protected under the Freedom of Information Act, the Privacy Act, or other authority.

d)Pertains to internal agency communications regarding the procurement (including the source selection plan, source selection evaluation board reports, technical analyses, and recommendations); or

e)Has been designated “Source Selection Information.”

1. If furnished with an offeror or submitter's proposal for submittal for evaluation, I shall:

a)Use the information contained therein only for GSA evaluation purposes;

b)Comply with any restrictive notice which may have been placed on the proposal by its originator or the Contracting Officer; and

c)Upon completion of the evaluation, return all copies of the proposal and abstracts, if any, to the GSA officer which initially furnished the proposal for evaluation.

1. I am aware that an unauthorized disclosure of procurement information may subject me to criminal, civil, and/or administrative penalties.
2. Appropriations Act restriction: These restrictions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by Executive Order No. 12958; section 7211 of title 5, United States Code (governing disclosures to Congress); section 1034 of title 10, United States Code, as amended by the Military Whistleblower Protection Act (governing disclosure to Congress by members of the military); section 2302(b)(8) of title 5, United States Code, as amended by the Whistleblower Protection Act (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the Intelligence Identities Protection Act of 1982 (50 U.S.C. 421 et seq.) (governing disclosures that could expose confidential Government agents); and the statutes which protect against disclosure that may compromise the national security, including sections 641, 793, 794, 798, and 952 of title 18, United States Code, and section 4(b) of the Subversive Activities Act of 1950 (50 U.S.C. 783(b)). The definitions, requirements, obligations, rights, sanctions, and liabilities created by said Executive order and listed statutes are incorporated into this agreement and are controlling.

User Certification:

______

(Signature) (Date)

______(Print or Type Name) (Company Name)

______

(E-Mail Address) (Phone Number)

Authorized Company Representative:

______

(Signature) (Date)

______

(Print or Type Name and Title) (Company Name)

______

(E-Mail Address) (Phone Number)

Certification Concerning Conflict of Interest

NAME ______

(Type or print)

You are being provided two copies of this Certification. Please sign, date, and return one copy to the GSA WITS Contracting Officer.

With respect to the WITSProgram, I hereby certify that:

1. I have read and understand the pertinent GSA Standards of Conduct (41 CFR 105735) relating to conflicts of interest and apparent conflicts of interest.
2. I am not aware of any other circumstances which would impair my exercise of independent judgment or my impartiality with respect to my duties in support of the abovecited acquisition.
3. I understand that I have a continuing obligation to disclose any circumstances that may create an actual or apparent conflict of interest. In the event that I become aware of any such conflict of interest, I agree to immediately report this fact to the GSA WITS Contracting Officer, Robert Clark, and take no further action concerning the procurement pending receipt of any instructions which he may give me in this matter.

______

(User Signature) (Date)

Version 2 (10/5/09)1 of 4