additions or modifications to this Agreement must be in writing and signed by both parties. Agreement is made under and shall be governed by the laws of the United States. Agreement may be terminated immediately by either party upon delivery of written notice of termination to the other party. Such termination shall not affect Recipient's duties with respect to confidential information disclosed prior to termination. The person has executed this Agreement as of the date below. ______________________________ ______________________ (Signature) (Date) ______________________________ ______________________ (Title) (Agency/Company*) ______________________________ ______________________ (Telephone Number) (Email Address) * If person signing this agreement is employed by a private company, the person shall also provide the name of the Agency they are assisting. The private employer shall complete a corporate non-disclosure and conflict of interest statement, if it has not already done so. Please sign, date, and return this certification to . If you have any questions or need assistance, contact the Help Desk at nhc@gsa.gov or 703-610-2142. CERTIFICATION CONCERNING CONFLICT OF INTEREST NAME ___________________________________ (Type or print)
additions or modifications to this Agreement must be in writing and signed by both parties. Agreement is made under and shall be governed by the laws of the United States. Agreement may be terminated immediately by either party upon delivery of written notice of termination to the other party. Such termination shall not affect Recipient's duties with respect to confidential information disclosed prior to termination. The person has executed this Agreement as of the date below. ______________________________ ______________________ (Signature) (Date) ______________________________ ______________________ (Title) (Agency/Company*) ______________________________ ______________________ (Telephone Number) (Email Address) * If person signing this agreement is employed by a private company, the person shall also provide the name of the Agency they are assisting. The private employer shall complete a corporate non-disclosure and conflict of interest statement, if it has not already done so. Please sign, date, and return this certification to . If you have any questions or need assistance, contact the Help Desk at nhc@gsa.gov or 703-610-2142. CERTIFICATION CONCERNING CONFLICT OF INTEREST NAME ___________________________________ (Type or print)
EIS_NDA_COI.docx