Respondents are required to complete the Conflict of Interest Form (on Respondent letterhead) and include it in the Executive Summary Folder of their Proposal.
[Insert State Representative's name]
[Insert State Representative's address]
[insert date]
Dear [Sir / Madam],
[Insert Project title] - Conflict of Interest Form
[Insert name of Respondent]:
The Respondent:
1) confirms, as required by Clause 7 of the Terms and Conditions set out in Appendix B to the Invitation for Expressions of Interest, that there is no conflict of interest in respect of the Project other than, where relevant, in respect of any disclosed conflicts which have been consented to by the State in writing;
2) confirms the structure and composition of the Respondent Member group as set out in its Expression of Interest dated [#insert date]; and
3) will advise the State if it proposes to change the structure or composition of the Respondent Member group.
Please provide details of any engagements, obligations or commitments that the Respondent or any of the persons referred to above have or are likely to acquire which may give rise to any actual or perceived conflict of interest with any aspect or element of the Project (including any of the services that may be required to be provided under or in connection with the Draft State Project Documents).
[Details to be inserted by Respondent]
Please advise details of any strategy for identifying, managing and preventing conflicts of interest.
[Details to be inserted by Respondent]
[Conflict of Interest Form to be signed by Project Co and all Respondent Members]