CONFLICT OF INTEREST FORM. Bidder shall complete the Conflict of Interest Form attached hereto and submit it with their bid.
CONFLICT OF INTEREST FORM. Quoter shall complete the Conflict of Interest Form attached hereto and submit it with their quote.
CONFLICT OF INTEREST FORM. The attached Conflict/Non-Conflict of Interest and Litigation Statement (with any applicable attachments) shall be completed and submitted with your proposal.
CONFLICT OF INTEREST FORM. A [board member/employee] of Academy (the “Academy”), being first duly sworn, depose and say that I have read the Academy’s Conflict of Interest Policy and the provisions of Act 317 of 1968 (MCL 15.321, et seq.) (“Act 317”), attached hereto, and other Michigan ethics or conflict of interest statutes, which may be applicable to my performance as a board member/employee of the Academy, and understand the terms of the Policy and Act 317 and further say that: 1) I am not in violation of the Policy, Act 317 or any such applicable ethics or conflict of interest statutes; 2) I agree to fully comply with such terms; and 3) I will notify the Chairman of the Academy Board and Secretary if at any time that I fail to comply with the provisions of the Policy, Act 317 or any such applicable ethics or conflict of interest statutes. [signature] Name of Academy Board Member or Employee Notary Subscribed and sworn to before me this day of , 20 . Notary Public My Commission Expires: 39 ACT 317 of 1968 (MCL 15.321, et seq.) This abstract is provided for convenience – parties should reference the actual statute.
CONFLICT OF INTEREST FORM. Detroit Public Schools Community District requires board members to complete an Annual Conflict of Interest Disclosure during their service to public school academy boards. This updated Annual Conflict of Interest Disclosure is to be completed and returned to the Detroit Public Schools Community District Office of Charter Schools by September 1 of each year. A conflict of interest occurs when your personal interests interfere, or appear to interfere, in any way, with the interests of the Academy and/or management company. A conflict of interest can arise either when you have interests that may make it difficult for you to fully perform your obligations or when you otherwise take action for your direct or indirect benefit, or the direct or indirect benefit of someone else that is inconsistent with the Academy’s interests. Conflicts of interest also arise when you, or a member of your family, receive improper personal benefits as a result of your position in the Academy. You have an obligation to disclose any fact, relationship or transaction that could reasonably be viewed as a potential or actual conflict of interest. Name: First Middle Last Name of Academy: Mailing Address: City State ZIP Home Phone: Cell Phone: Email Addres s: Please complete the following section by indicating yes or no. If you answer “yes” to any questions, please provide an explanation on a separate page. Label explanations with the number of the corresponding question.
CONFLICT OF INTEREST FORM. Manuscript ID Manuscript title As the corresponding author, I declare the following information regarding the specific conflicts of interest of authors of our aforemen- tioned manuscript. Examples of conflicts of interest include the following: source of funding, paid consultant to sponsor, study investigator funded by sponsor, employee of sponsor, board membership with sponsor, stockholder for mentioned product, any financial relationship to competitors of mentioned product, and others (please specify). Author No conflict involved Conflict (specify) 1. 2. 3. 4. 5.
CONFLICT OF INTEREST FORM. Offerors must include signed and completed Conflict of Interest Form (APPENDIX E) with RFP Documents. The Offeror warrants that it presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance or services required under the Agreement. The Offeror certifies that the requirements of the Governmental Conduct Act, Sections 10-16-1 through 10-16-18, NMSA 1978, regarding contracting with a public officer or state employee or former state employee have been followed.
CONFLICT OF INTEREST FORM completed by each member of the planning committee and each presenter (available on website)
