ATTACHMENT VI CONFLICTS

ATTACHMENT VI CONFLICTS OF INTEREST STATE OF LOUISIANA PARISH OF__________________ ACKNOWLEDGMENT BEFORE ME, the undersigned authority, personally came and appeared: who after first by me being duly sworn, did depose and state that he/she has read the Louisiana Code of Governmental Ethics and the DOI Policy Statement regarding conflicts of interest, as well as reviewed the work that they are performing for the Louisiana Department Of Insurance and Appearer further declared that to the best of his/her knowledge, under penalty of perjury, there is no conflict of interest. Appearer did further acknowledge that it is his/her duty to immediately report to the Chief Deputy Commissioner of Insurance or his/her designee any and all conflicts of interest of which appearer may become aware in the future, except as disclosed and acknowledged by written waiver. ___________________________ Date 60

ATTACHMENT VII CONFIDENTIALITY While the majority of the business conducted by the Department of Insurance is public information, confidentiality of certain information is, and must be, a high priority. The decision as to what information to release, and when, is one for the Commissioner of Insurance to make in each instance. Accordingly, the Contractor hereby agrees that in furtherance of this objective the Contractor will not release any information concerning the work done in connection with this contract which he possesses, or may, from time to time, come to possess, without the express written authorization of the Commissioner of Insurance or his designee. Any Contractor who does not abide by this policy is subject to cancellation of this contract, and such other action as may be appropriate under the circumstances. ___________________________ Date 61