Procurement driving better value for money

Conflict of Interest and Confidentiality Agreement

Who and when?
Anyone involved in a procurement activity must complete this agreement before developing tender
documents, joining an evaluation panel or making a decision. Before you complete this form, read the
Quick-Guide: onflicts of !nterest.
Name:
Position:
Organisation:
ender:
!ole in the "rocurement
activity:
In a small country like ours, conflicts of interest in our working lives are natural and unavoidable. The
existence of a conflict of interest does not necessarily mean that someone has done something wrong,
and it need not cause problems. It just needs to be identified and managed carefully.
ontroller " Auditor-General
#o you have any actual$ "otential or "erceived conflicts of interest?
#o you have any personal interest in the purchasing decision$
e.g. you own shares in a supplier or related company!
%es No Potentially %tick
&potentially' if others could perceive you have
a conflict(
Are you a relative or close friend of someone )ith a personal interest in
the goods or services being purchased or )ho could be personally
affected by the purchasing decision$
%e.g. a family member is an employee or shareholder of a supplier!
%es No Potentially %tick
&potentially' if others could perceive you have
a conflict(
#o you have any personal obligations, loyalties or bias that could
influence the )ay you evaluate offers and recommend purchases$
e.g. a close friendship with an employee of a supplier!
%es No Potentially %tick
&potentially' if others could perceive you have
a conflict(
*ave you recently been offered any special discounts, gifts, trips,
hospitality, re)ards or favours by suppliers of the goods or services being
purchased$
e.g. free travel" free samples for your own use!
%es No Potentially %tick
&potentially' if others could perceive you have
a conflict(
Are you a)are of anything that could give the appearance that you might
be biased to)ards or against a particular supplier$
e.g. you have expressed strong views about a supplier" you worked for a
supplier" you use a supplier#s corporate box at a sports event!
%es No Potentially %tick
&potentially' if others could perceive you have
a conflict(
Crown Co"yright
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Procurement driving better value for money
Confidentiality res"onsibilities
All of the procurement project's discussions, meetings and material %)ritten and electronic( are confidential
and ! agree to keep this information safe. ! )ill not give this information to anyone outside the immediate
tender team )ithout prior approval from the 0roject 1anager.
!estrictions on contact with su""liers
! agree that my contact )ith potential suppliers is restricted during the period of the tender. ! understand that
until the successful supplier has been announced ! )ill not:
pass information or make comments to them about the tender
receive any gift, gratuity, hospitality or any inducement from them
meet them or have any discussion about the tender.
! )ill pass any re2uests for information and meetings from potential suppliers to the 0roject 1anager.
#eclaration of conflict of interest
Actual conflict of interest is
)here you already have a
conflict.
Potential conflict of interest is
)here the conflict is about to
happen or could happen.
Perceived conflict of interest is
)here other people might
reasonably think you are not
being objective.
!f you have ans)ered &%es' or &Potentially' to any of the above 2uestions, please
provide details here. 3ther)ise sign the declaration belo).
%our declaration
#eclaration ! confirm that the above details are correct to the best of my kno)ledge and ! make this
declaration in good faith.
4ignature: #ate:
!eview by Pro(ect )anager ! confirm that ! have received this declaration and noted the contents.
5here a conflict of interest is declared, complete the ne6t part of the form.
7ame:
4ignature: #ate:
Crown Co"yright
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Procurement driving better value for money
Conflict of Interest )anagement Plan
Who and when?
9he 0roject 1anager must complete this 0lan )hen you declare a conflict of interest. #ecide ho) to
manage the conflict and give details belo).
ender:
*ow the conflict of interest will be managed
here are five o"tions for
managing or resolving your
conflict of interest:
!estrict your involvement in
the process
!ecruit an independent third
party to oversee part or all of
the process
!emove yourself from the
process
!elin+uish your private interest
that causes the conflict
!esign from the agency
9he follo)ing plan has been agreed to manage your declared conflict of interest.
9his takes into account the conflict's likely effect on your role and responsibilities
in the procurement activity, as )ell as the risks to the process and the agency's
reputation.
A""roval : ! approve the above onflict of !nterest 1anagement 0lan
4ignature:
0roject 1anager
#ate:
#eclaration : ! agree to the above onflict of !nterest 1anagement 0lan
4ignature:
0erson making the declaration
#ate:
!esolved : the conflict of interest has no) been resolved and no further action is re2uired
4ignature:
0roject 1anager
#ate:
Crown Co"yright
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