VENDOR RELATIONSHIP DISCLOSURE FORM
In accordance with Texas Tech University System policies and State of Texas laws, no employee of the System shall be interested in, or in
any manner connected with, any contract or procurement for furnishing supplies, materials, services, and equipment of any kind to any
agency of the State of Texas without disclosing that relationship and ensuring that the conflict of interest policy is not compromised.
Neither shall any employee accept or receive from any person, firm, or corporation to whom any contract may be awarded, directly or
indirectly, by rebate, gift, or otherwise, any money or other thing of value, nor shall any employee receive any promise, obligation, or
contract for future reward or compensation from any such party.
In addition to the aforementioned, I certify that I understand the Conflict of Interest policy and that I am not related by blood or marriage to
any employee of a vendor company which might cause a conflict of interest. If such relationship exists, then that relationship shall be
disclosed on this form and management shall be notified if such relationships change throughout the fiscal year. This form shall be updated
annually by all staff members of the Physical Plant.
Any violation of this Conflict of Interest policy could result in disciplinary action.
Name
Name of Related Party
Signature
Relationship to employee
Name of vendor for which the
related party works for
Date
Does this vendor participate in
contracts or purchases with the
University?
Notes:
PP/OP 05.06
01/27/2011
Attachment B