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EMPLOYMENT AND <br /> ECONOMIC DEVELOPMENT Conflict of Interest Disclosure <br /> State of Minnesota <br /> Request for Proposals <br /> Instructions: Please return your completed form as part of the Response submittal. <br /> Conflict of Interest Disclosure Form <br /> This form gives applicants and grantees an opportunity to disclose any actual or potential conflicts of <br /> interest that may exist when receiving a grant. It is the applicant/grantee's obligation to be familiar with <br /> the Office of Grants Management(OGM)Grants Policy 08-01 Conflict of Interest Policy for State Grant- <br /> Making effective date 1/1/21 and to disclose any conflicts of interest accordingly. <br /> All grant applicants must complete and sign a conflict of interest disclosure form. <br /> ❑ I or my grant organization do NOT have an ACTUAL or POTENTIAL conflict of interest. <br /> If at any time after submission of this form, I or my grant organization discover any conflict of interest(s), <br /> I or my grant organization will disclose that conflict immediately to the appropriate agency or grant <br /> program personnel. <br /> ❑ I or my grant organization have an ACTUAL or POTENTIAL conflict of interest.(Please <br /> describe below): <br /> If at any time after submission of this form,I or my grant organization discover any additional conflict of <br /> interest(s),I or my grant organization will disclose that conflict immediately to the appropriate agency or <br /> grant program personnel. <br /> Printed name:Tyler Gardner, Mayor <br /> Signature: <br /> Organization:City of Pequot Lakes <br /> Date: <br /> Page 31 of 72 <br />