Attachme ent 3: Confflict of Inte erest Affid davit By the signature below B w, the firm m (employees, officerss and/or ag gents) certifies, and hereby h disccloses, tha at, to th he best of their know wledge and belief, all relevant fa acts concerrning past, present, or o currentlyy planned in nterest or a activity (financial, con ntractual, o organizatio onal, or otherwise) wh hich relatess to the pro oposed wo ork; a bear on and n whether the firm (e employees,, officers and/or agen nts) has a p possible co onflict have e been fullyy d disclosed. Additionallyy, the firm (employee A ( s, officers and/or age ents) agree es to imme ediately notify in writin ng the P Purchasing g/General Services S Director, or designee, if any actu ual or poten ntial conflic ct of interest arises during th he contracct and/or prroject duration.
F Firm:
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S Signature a Date: and
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P Print Name e
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T Title of Sign natory
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S State of
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C County of
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SUBSCRIB S BED AND SWORN S to o before me e this ____ _________ _ day of __ _________ _________ _, 2 20_______ _____, b _______ by _________ _________ _________ _________ _________ _, who is pe ersonally known k to m me to be the e _ _________ _________ __________ __________ _______ fo or the Firm m, OR who produced the following identificcation _ _________ _________ __________ __________ _______.
N Notary Pub blic
My Commission Exp pires _ _________ _________ __________ __________ _________ __