None Disclosure

NON-DISCLOSURE AND CONFLICT OF INTEREST STATEMENT

(Contract Employee)

 NAME |   |

JOB TITLE |   |

COMPANY NAME |   |

CONTRACT |   |

SPONSORING ORGANIZATION |   |

1. I acknowledge that my contract responsibilities cause me to have access to acquisition information to include entering data in funding documents (e.g., MIPR, AF Form 9). I am aware that unauthorized disclosure of budget or funding information damages the integrity of the procurement process. I am also aware that the transmission or revelation of such information to unauthorized persons could subject me to prosecution under the Procurement Integrity Laws or under other applicable laws.

2. I will not divulge, publish, or reveal by word, conduct, or any other means, such information or knowledge, except as necessary to do so in the performance of my official duties related to any procurement, proposed or actual, and in accordance with the laws of the United States, unless specifically authorized in writing in every case by a duly authorized representative of the United States Government.

3. I acknowledge that the information I receive and/or enter into Government data systems will be given only to persons specifically granted or authorized access to the procurement and budget/funding information and may not be further divulged without specific prior written approval from an authorized individual.

4. If, at any time during the course of a procurement, including, but not limited to, the award of contract, modification, or task order in which I had access to any Government information, including budget and/or funding information, my participation might result in a real, apparent, possible, or potential conflict of interest, I will immediately report the circumstances to the appropriate authorized individual; i.e., Contracting Officer, local Counsel, or Source Selection Authority.

SIGNATURE: |   |   | DATE: |   |