Clean Mobility Voucher Pilot Program: CONFLICT OF INTEREST DECLARATION The awardee must disclose any Conflict of Interest with their ability to fulfill the duties of the Clean Mobility Voucher Pilot Program Voucher Agreement (Voucher Agreement). Please summarize all of your organization’s or any subcontractor’s/project partner's direct or indirect interests which may pose an actual, apparent, or potential conflict of interest with your ability to fulfill the duties of the Voucher Agreement. Please note that a potential or actual conflict of interest exists when commitments and obligations under the Voucher Agreement are likely to be compromised by the awardee’s or any subcontractor’s/project partner's other interests (including but not limited to financial interests), or relationships, particularly if those interests or commitments are not disclosed. The Program Administrator may consider the nature and extent of any potential or apparent conflict of interest in reviewing, considering, or processing the voucher application or voucher implementation activities, and may disqualify the awardee/voucher recipient at the Program Administrator's sole discretion.
Please describe below any interests (including but not limited to financial interests), relationships, or positions you or any of your organization’s or subcontractor’s/project partner’s hold (volunteer or otherwise), or circumstances that you believe could contribute to a conflict of interest:
To my knowledge, my organization/ subcontractor/ project partner does not have a Conflict of Interest to disclose.
My organization/ subcontractor/ project partner has a Conflict of Interest to disclose and I have included the appropriate documentation.
Signature of Responsible Party Date
Typed Name of Responsible Party
Typed Name of Organization
Exhibit G