Procurement Committee Conflict of Interest Disclosure Form

Name: Position/Title: Department: Date:

Conflict of Interest Disclosure

Please disclose any personal, professional, or financial interests that may be perceived as a potential conflict of interest with your duties as a member of the Procurement Committee: List any relationships or affiliations with vendors, contractors, or parties seeking to do business with the organization: Other relevant information:

I certify that the information provided above is true and complete to the best of my knowledge.