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UDOT Conflict of Interest (COI) or Unfair Competitive Advantage (UCA) Submission Form
Please provide responses to the questions below in relation to the COI or UCA for which you are requesting a response from the UDOT COI Committee.
For additional information see the
UDOT COI Committee Outline
or the
UDOT Guidance for Consultant COI
.
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* Indicates required question
Email
*
Your email
Submitter Firm or Agency:
*
Your answer
Submitter Name (first and last):
*
Your answer
Submitter Phone No.:
*
Your answer
UDOT Project PIN No (or N/A)
:
*
Your answer
UDOT Project Description
(or N/A):
*
Your answer
Identify the party(ies) or person(s) involved (role, firm, individual, etc.) and their contact information (email and phone):
*
Your answer
State the nature of the potential COI or UCA:
*
Your answer
Detail the potential COI or UCA relationship or activity and why it constitutes a potential COI or UCA:
*
Your answer
Propose potential mitigation(s) to address the concern (or N/A):
*
Your answer
Add any other information that may be of relevance such as procurement schedules, timing overlaps, previous involvement in project, what information is being shared, etc. (or N/A):
*
Your answer
Date a determination is needed by (response time may be contingent on COI Committee availability):
*
Your answer
A copy of your responses will be emailed to the address you provided.
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