RCUH Policies and Procedures
State of Hawaii
Affidavit
Serving on an Evaluation, Review, or Selection Committee
1. Committee member is a:
Governmental Employee
Non-Governmental Employee
2. Purpose of committee:
Request for Proposals – Evaluation committee to evaluate Request for Proposals No. (3) ___________________________ (Reference HAR 3-122-45.01)
Professional Services – Review committee to review statements of qualifications and expression of interest from professional services providers to establish a list of qualified persons
Professional Services – Selection committee to evaluate the submissions of the persons on the list of qualified persons against the selection criteria (Reference HAR 3-122-69)
I, _____________________ (4) Print Name, attest to the following:
I have no personal, business, or any other relationship that will influence my decision in the applicable evaluation, review, or selection process.
I agree not to disclose any information on the applicable evaluation, review, or selection process; and
I agree that my name will become public information upon award of the contract.
________________________
(5. Signature)
________________________
(6. Date)
Affidavit
Serving on an Evaluation, Review, or Selection Committee
1. Committee member is a:
Governmental Employee
Non-Governmental Employee
2. Purpose of committee:
Request for Proposals – Evaluation committee to evaluate Request for Proposals No. (3) ___________________________ (Reference HAR 3-122-45.01)
Professional Services – Review committee to review statements of qualifications and expression of interest from professional services providers to establish a list of qualified persons
Professional Services – Selection committee to evaluate the submissions of the persons on the list of qualified persons against the selection criteria (Reference HAR 3-122-69)
I, _____________________ (4) Print Name, attest to the following:
I have no personal, business, or any other relationship that will influence my decision in the applicable evaluation, review, or selection process.
I agree not to disclose any information on the applicable evaluation, review, or selection process; and
I agree that my name will become public information upon award of the contract.
________________________
(5. Signature)
________________________
(6. Date)