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Complete Form

EX. D

Federal Funding Subrecipient Conflict of Interest Annual Affirmation of Compliance - Board of Directors

 

I have received and carefully read the BBBSA Conflict of Interest Policy and have considered the literal expression of the policy and its intent. By signing this affirmation, I confirm that I understand and will comply with the Policy. I further understand that BBBSA is a nonprofit organization and that, in order to maintain its federal tax exemption, it must engage primarily in activities that accomplish one or more of its tax-exempt purposes without personal gain (other than by salary) by board members or staff.

 

I further understand that where a potential conflict exists between the interests of BBBSA and a board member with respect to a proposed action, policy or transaction, the Board of Directors shall consider the matter during a board meeting at which there is a quorum.

 

I understand that approval by the disinterested members of the Board of Directors shall be by vote of a majority of directors in attendance. An interested party shall not be counted for purposes of determining a quorum or for determining what constitutes a majority vote. Meeting minutes will reflect that a conflict disclosure was made to the board, the vote taken and, where applicable, the abstention from voting and participation by the interested party. Whenever possible, the minutes should frame the decision of the board in such a way that it provides guidance for consideration of future conflict of interest situations.

 

Except as otherwise indicated below, I hereby state that I do not have any conflict of interest, financial or otherwise, that may be seen as competing with the interests of BBBSA, nor does any relative or associate have such a potential conflict of interest, nor shall I, any relative, or associate benefit from any action, policy, or transaction made by BBBSA in a manner that has not been previously disclosed.

 

If any situation arises in the future that I think may involve me in a conflict of interest, I will make a prompt and full written disclosure of the circumstances.

Name:

NAME

Date:

Sign:

Ensure all required fields are completed.

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