Board Of Directors / PAC Conflict of Interest Disclosure Statement
I affirm that I have read and understand the Disability Rights North Carolina (DRNC) Board of Directors/PAIMI Advisory Council (PAC) Conflict of Interest policy and that I will abide by the terms of this policy at all times during my tenure as a member of DRNC’s Board of Directors/PAC. I understand and agree that my election to the Board of Directors/PAC carries with it the legal and fiduciary responsibility to act on all matters affecting DRNC in good faith with a view to the interests of DRNC, placing those interests above any personal interest I may have on any matter at issue. I also understand and agree that, in discharging my responsibilities as a director, I will exercise that degree of diligence, care, and skill which an ordinarily prudent person would exercise in my position under similar circumstances.
Consistent with policies established by DRNC, I hereby certify that the following is a true and complete disclosure of my relationships, if any, to affiliations, businesses, agencies, organizations, or other groups which have the potential of creating an actual or apparent Conflict of Interest in carrying out my responsibilities as a director/member of DRNC.
“Conflict of Interest” is a conflict between my private interests and my official responsibilities as a director/member of DRNC. A conflict of interest arises when I have a private interest that reduces the likelihood that my participation can be exercised impartially in the best interest of DRNC.
“Immediate Family member” means a person related to as a spouse or similar domestic partner; parent or step-parent; sibling (including brother-in-law or sister-in-law); or child or stepchild.
Initial as applicable
Financial Conflict of Interest: I am (or my immediate family member is) an employee, officer of director, or have an ownership interest of 10% or more in the following for profit business(es), other not-for-profit organization(s), or a governmental agency(ies) which provide a service to persons with disabilities that a reasonable person might consider having the potential to create a conflict of interest in fulfilling my duties as a director/member of DRNC (include name of business, organization or agency; type of service (whether paid or volunteer) and the relationship that creates a conflict of interest). I further understand and agree that I am obligated to abstain from debating and voting on any issue related to said conflict of interest:
Service Conflict of Interest: I am (or my Immediate family member is) an employee, officer, or director of the following agency(ies) or organization(s) which is primarily related providing a service to persons with disabilities (include name of agency or business; type of service and the relationship that creates the conflict of interest). I further understand and agree that I am obligated to abstain from debating and voting on any issue related to said conflict of interest:
No Conflicts of Interest: Neither I, nor any of my immediate family members, is an employee, officer, director, or has a significant ownership interest in any business(es), organization(s), agency(ies), or group(s) providing any type of service that might create the appearance of a conflict of interest. I further understand and agree that, should I become aware of any actual, potential, or perceived conflict of interest, I am obligated immediately to disclose such conflict of interest and abstain from voting on any issue related to said conflict of interest.