RES 215 Draft 01 2010-2012 - Laserfiche WebLink

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For the purposes of this declaration: "Agency" means and includes the State, the legislature and its committees, all exe tive departments, boards, commissions, committees, bureaus, offices; and all ind endent commissions and other establishments of the state government but excluding the co "Controlling interest" means an interest in a business or other undertaking which iB/sufficient in fact to control, whether the interest is greater or less than fifty per cent (50 %). "Employee" means any nominated, appointed, or elected officer or empl ee of the State, including members of boards, commissions, and committees, and employ =-s under contract to the State or of the constitutional convention, but excluding legisl ors, delegates to the constitutional convention, justices, and judges. (Section 84 -3, HRS). On behalf of undersigned does declare as follows: 1. CONTRACTOR ❑ is ❑ is not a legislator or an employee . r a business in which a legislator or an employee has a controlling interest. (Section 84- 15(a), ' RS). 2. CONTRACTOR has not been represented or assisted p onally in the matter by an individual who has been an employee of the agency awarding this"Contract within the preceding two years and who participated while so employed in the utter with which the Contract is directly concerned. (Section 84- 15(b), HRS). 3. CONTRACTOR has not been assisted or represe ed by a legislator or employee for a fee or other compensation to obtain this Contract and w not be assisted or represented by a legislator or employee for a fee or other compensation the performance of this Contract, if the legislator or employee had been involved in the dev opment or award of the Contract. (Section 84 -14 (d), HRS). " 4. CONTRACTOR has not been reps ented on matters related to this Contract, for a fee or other consideration by an individual o, within the past twelve (12) months, has been an agency employee, or in the case of th egislature, a legislator, and participated while an employee or legislator on matters related td this Contract. (Sections 84 -18(b) and (c), HRS). THIS FORM IS DELETED AND INOPERATIVE STATE OF HAWAII CONTRACTOR'S OFC DUCT DECL A "l'lON , CONTRACTOR, the CONTRACTOR understands th`the Contract to which this document is attached is voidable on behalf of the STATE if this Contrac was entered into in violation of any provision of chapter 84, Hawaii Revised Statutes, commonly referred to as the Code of Ethics, including the provisions which are the source of the declaration above. Additionally, any fee, compensation, gift, or profit received by any person as a result of a v ation of the Code of Ethics may be recovered by the STATE. *Reminder to A • en • If the "is" block is checked and if the ontract involves goods or services of a va e in excess of $10,000, the Contract mus .e awarded by competitive sealed bidd g under section 103D -302, HRS, or a com • - titive sealed proposal under section 103D- 13, HRS. Otherwise, the Agency may not . ' and the Contract unless it posts a notice of ''s intent to award it and files a copy of the otice with the State Ethics Commission. (Section 84- 15(a), HRS). AG -010 Rev 11/15/2005 CONTRACTOR By (signature) Print Name Print Title Name of Contractor Date