Attachment A CONFLICT OF INTEREST DISCLOSURE FORM FOR ACT NATIONAL CAREER READINESS CERTIFICATE (NCRC) CONSULTANT NAME OF ORGANIZATION: ____________ Please list any and all individuals who assisted, contributed and/or substantially influenced the writing, research, preparation and submission of this quote: Are any of the individuals involved in the writing, preparation, research and/or submission of this quote, members of Workforce Development Board, San Diego Consortium Policy Board, Adult Programs Committee, Youth Council and SDWP staff? If yes, please list those individuals: Were any of the individuals involved in the writing, preparation, research and/or submission of this quote, employed by SDWP within the last twelve (12) months? If yes, please list those individuals: If applicable, please describe any additional Conflict of Interest disclosures below. I certify that the organization listed above has no conflict of interest as stated in the Request for Quotes. Name: Signature: _______________________________ Date: ______________________________
Attachment A CONFLICT OF INTEREST DISCLOSURE FORM FOR ACT NATIONAL CAREER READINESS CERTIFICATE (NCRC) CONSULTANT NAME OF ORGANIZATION: ____________ Please list any and all individuals who assisted, contributed and/or substantially influenced the writing, research, preparation and submission of this quote: Are any of the individuals involved in the writing, preparation, research and/or submission of this quote, members of Workforce Development Board, San Diego Consortium Policy Board, Adult Programs Committee, Youth Council and SDWP staff? If yes, please list those individuals: Were any of the individuals involved in the writing, preparation, research and/or submission of this quote, employed by SDWP within the last twelve (12) months? If yes, please list those individuals: If applicable, please describe any additional Conflict of Interest disclosures below. I certify that the organization listed above has no conflict of interest as stated in the Request for Quotes. Name: Signature: _______________________________ Date: ______________________________
rfq_-_act_consultant_-_attachment_a-_conflict_of_interest_disclosure.docx