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TECHNICAL EVALUATION REPORT (EXAMPLE FORMAT- Use this format to send your report to the CS/CO) To: (Insert CO/CS name and Title) From: (Insert name of the Chairperson) Technical Evaluation Panel Chairperson Subject: Solicitation Number: (Insert Solicitation number and Description of Services) 1.. EXHIBIT II COMPOSITE EVALUATION SHEET Solicitation Number: (Insert solicitation number and Description of Services) Name of Offeror Panel Member 1 Total Score Panel Member 2 Total Score Panel Member 3 Total Score Panel Member 4 Total Score Average Score A EXHIBIT III CONFLICT OF INTEREST AND NON-DISCLOSURE STATEMENT I acknowledge that I have been selected to participate in the source selection of Solicitation Number: (Insert solicitation no.. Printed Name: Signature: Position: Organization: Date: EXHIBIT IV FEDERAL PROCUREMENT INTEGRITY ACT Subsection 27(d)(7)(A) of the Office of Federal Procurement Policy Act, 41 U.S.C. 423 (hereinafter the Act), and Sections 3.104-1 through 3.104-9 of the Federal Acquisition Regulation (FAR), require certification that individuals who participate in the preparation and/or submission of bids and/or offers for which the undersigned has participated or will participate in personally and substantially declare that they are familiar with and will comply with the requirements of subsection 27(a) of the Act and FAR 3.104-3 as follows: During the course of any federal agency procurement of products or services, I understand and certify that I will observe the following rules of conduct: a..