Please note: Portland Downtown’s Office Manager will provide a hard copy of the Conflict of Interest & Confidentiality Agreement for new board members to sign & date.
This disclosure is provided to assist management at Portland Downtown (PD) in developing and adhering to a policy that seeks to identify any conflict of interest by Directors, members of committees with board delegated powers, and employees in positions to make or influence decisions that may be affected or perceived to be affected by such possible conflict.
I hereby state that I have received a copy of the conflict of interest policy, have read and understand the policy, agree to comply with the policy and understand that the policy applies to all committees and subcommittees having board delegated powers.
I hereby state that I, and members of my immediate family, have the following affiliations or interests, and have taken part in the following transactions which, when considered in conjunction with my position with or relation to PD, may reflect a conflict or possible conflict of interest. In my opinion, none of the interests disclosed below place me in a position of having a conflict with PD.
1. Members of My Immediate Family:
Maine law requires disclosure of whether there are certain family members who within the last twelve months (a) have received compensation from PD or an affiliated organization or (b) are entitled to receive net income from a business that has been paid for services provided in that period to PD or an affiliated organization. Those family members to be identified are spouses, siblings, parents, and children. The IRS requires similar disclosure if the board is to consider financial transactions involving such relatives as well as half-siblings, grandchildren, and great grandchildren. Please identify any such relatives and the general nature of any such financial transactions with PD.
I hereby disclose for myself and members of my immediate family any;
- Actual or potential employment with or a financial interest (ownership, investment and/or compensation arrangements) in any suppliers (or possible suppliers) of goods or services to PD.
- Actual or potential employment or financial interest in any entity which is in competition with PD.
- Actual or potential employment or financial interest in any entity which is in competition with PD for the purchase or sale of property or services.
3. Acceptance of Gifts or Hospitality:
I hereby certify that neither I nor any member of my immediate family has accepted gifts, gift certificates or entertainment that might tend to influence my judgment or actions concerning the business of PD, except as listed below.
I also hereby disclose any other activities in which I or my immediate family may be engaged where my duties to PD may be compromised by a competing interest that could possibly be regarded as constituting a conflict of interest as described in the guidelines.
I hereby agree to report to the Chair of the Board of Directors any further situation that may develop before completion of my next disclosure form.
In the course of my association with PD and its affiliated organizations, I may use or come into contact with nonpublic confidential information. The nonpublic information may be valuable to PD and should be kept confidential, except as required in the performance of your Director duties. All PD Directors shall refrain from using or discussing confidential information with individuals who do not need to know. I understand I may be asked to resign if I violate my confidentiality obligations, without limiting any other rights or remedies that PD may have against me. Any Director who is uncertain of the applicability of this confidentiality policy or individual responsibilities relating to it should seek clarification and guidance before acting from your Board Chair or Executive Director.
I have reviewed and understand PD’s policy regarding Conflict of Interest and this Confidentiality Statement and I agree to comply with them. I certify that my answers on this form are complete and accurate to the best of my knowledge. I agree to report promptly any new activity with the potential for a conflict of interest.