APPENDIX F-1

EXAMPLE OF CONFIDENTIALITY AGREEMENT

Arkansas State Highway and Transportation Department

[PROJECT NAME]

PROJECT CONFIDENTIALITY AGREEMENT

Project: ____________

I, ____________, hereby agree as follows: (print first and last name)

Except as otherwise permitted by this Agreement, I will maintain the confidentiality of any and all information relating to the consideration, study, evaluation, planning, procurement and development of the above listed project (Project) administered by the Arkansas State Highway and Transportation Department (AHTD) that I am allowed access in the course and scope of my employment or assignment with the AHTD. This agreement includes, but is not limited to, proprietary information, information designated "Confidential" by the AHTD or by any Proposer, information discussed at meetings or contained in minutes or notes of those meetings, Statements of Qualification, Proposals, including Technical and Price Proposal information, and requests submitted by any Proposer, information regarding project cost estimates, any Proposer Alternative Technical Concept, project development or financing plans, or any other information related to the Design-Build procurement process that I may acquire access in connection with the performance of my job duties (Confidential Information).

I will not, without the prior written consent of the Project Director, the AHTD Director, or unless ordered by a court of competent jurisdiction, or an opinion of the attorneys retained by the AHTD, or as otherwise required by law, disclose any Confidential Information to the public or the media, or use any Confidential Information for any unauthorized purpose. I will only communicate Confidential Information to the AHTD employees or consultants retained by the AHTD for administration of the Project who have executed this Project Confidentiality Agreement, attorneys retained by the AHTD who have executed this Project Confidentiality Agreement and are representing the interests of the AHTD in a matter related to the Project. If contacted by the public, the media, or a member of any Proposer team with a request for Confidential Information, I will promptly forward such request to the Project Director. I will also maintain security and control over all documents containing such Confidential Information in my custody.

Signed: ________ Date: ______

Printed Name: ________ Title: ______

Company/Organization: ____________

APPENDIX F-2

EXAMPLE OF CONFLICT DISCLOSURE STATEMENT

Arkansas State Highway and Transportation Department

[PROJECT NAME]

PROJECT CONFLICT DISCLOSURE STATEMENT

Project: ____________

☐ RFP Development

☐ SOQ Evaluation

☐ ATC Review

☐ Proposal Evaluation

I, ____________, hereby declare the following: (print full name)

I am a member of the team supporting the Project procurement process for the above listed project (Project) administered by the Arkansas State Highway and Transportation Department (AHTD); developing the Request for Qualifications (RFQ), Request for Proposal (RFP) or a member of the Evaluation Team participating in the evaluation of documents submitted in response to the RFQ, RFP or otherwise reviewing documents provided by a Proposer related to the Project, such as an Alternative Technical Concept (ATC). I have disclosed any potential conflicts of interest on the attached Disclosure Statement Form, or alternatively, I hereby certify that to the best of my knowledge, I do not have a conflict of interest, either real or perceived, as a result of a direct or indirect interest on my part or that of any member of my immediate family, nor of my employer (if applicable), partner(s), or joint ventures in any firm under consideration for the Agreement associated with the Project. I agree not to solicit or accept gratuities, unwarranted privileges or exemptions, favors, benefits or anything of value from any firm under consideration for the Agreement associated with the Project, and I recognize that acceptance of any benefit or privilege may be contrary to statutes, ordinances and rules governing or applicable to the AHTD or may otherwise be a violation of the law.

☐ No Disclosure Statement Form Required

☐ See Attached Disclosure Statement Form

Signed: ____________ Date: ______

Printed Name: ____________ Title: ______

Representing: ____________

E-mail: ____________

Business Phone / Extension: (_) - / (_) ______