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DocuSign Envelope ID:87560079-2786-4376-A189-DC48D9482BE7 <br /> is <br /> s�d�° • a _ .d <br /> ■ �a NC DEPART IsTT of PUBLIC.SAFETY�� NOT FOR PRQlTI'• <br /> 7 -� BPS CONFLICT OF INTEREST POLICY STATEMENT <br /> The following serves to identify and document any personal interest staff members, <br /> officers, and members of the Board ofDzrectoi.s"may have• This document is also to be <br /> used to disclose any transactiorfs that.May result in personal,financial professional <br /> • and/or�Political.gain at the expense.of,DPS.. The statement requires that all personal <br /> relationships that may inci. rap riatel - influence ias . actions be disclosed <br /> Relatoriships,be.it persorial;.f_rnancial,' irofessionaland/or_political are required to be <br /> disclosed to Nis. CorifZici means a conf liet or the.appearance of a Conflict between the <br /> private interests and officud responsihilzt es of a person in a position of trust .Persons <br /> in it position of trust include staff Members Or.the.Board of Directors. <br /> • Private, nonprofit entities shall make fun disclosure by notice in writing to the full <br /> Governing Board/Council all Coittlicti of interest, if"yes"is answered to any of the <br /> • following: (Check.all that apply). . . - <br /> • .• 1: A Board member is related to_a staff member:: . 1 1 IZI <br /> 2.. ••A staff member in a supervisory capacity is related to another staff 1 . A•• <br /> ieinber whoni he/she supervises.'• '•. - • . <br /> 3. A staff member is related to ai..other staff Member. . .. . f l V <br /> 4.-'••A board memberor•staff member.has or.mayhave personal,• • - I I . L <br /> .:fO aanciai,professional,and/or political gain at the expense or• <br /> benefit of the private,nonprofit entity•••° : •: • • - - . .: <br /> 5.. •There as a business entity which a.•staff,_ ioard,,or family member C. El <br /> • . • •participates that may be viewed�as.having direct oradirect •, <br /> . .': . influence over the private,'nohprof f entity's business. <br /> .'6. A staff board'or family member.ma beviewed.as having direct • ' C . <br /> .. •or indirect f nan.cial g from.personal orbirsiness .:` . .•investments/interest in real ro held• by that sta board,or . <br /> p P y <br /> .family biember:'• :::' :.:': : •• ::'f,'.-• :'`°••. . . :. • .•• . - •• . • • <br /> • 7: :A staff or board member received honorarium-or other• ` . •C - <br /> : compensataon.'outside of the scope of ernployment/operations.with • ' <br /> . •. the private,nonprofit eiitity"that creates'or appears td create bias: <br /> . S: A_staff or board member secured employment with a competitor or [ El <br /> .`'. other similar private,noiiprd t entity•': . :.,. <br /> .9.... . Ongoing,paid consulting work outside of the staff member's <br /> current employment orboard member's with your'private, :, . <br /> -nonprofit entity exists. • <br /> • <br /> Form:DPS 13 0.01 Not for Profit DPS Conflict of Merest Po7 cy Statement • <br /> ' •• Form structure last_revised.July 204- ,. . <br /> .1\Ta:.pelithimept ofPuiblic Safety • . Page 2 of 3 <br />