Annual Conflict Of Interest

LWSC Board Annual Conflict of Interest Form

Please complete the questionnaire below, indicating any potential conflicts of interest. If you answer "yes" to any of the questions, please provide a written description of the details of the specific action, policy or transaction in the space allowed. Attach additional sheets as needed. A conflict may exist where an interested party directly or indirectly benefits or profits as a result of a decision, policy or transaction made by Lake Washington Saddle Club (LWSC). The interested party would not have obtained this benefit were it not for his/her relationship with LWSC.

Conflict of Interest Affirmation of Compliance

I have received and carefully read the Conflict of Interest Policy for board members, committee members and show managers. I have considered not only the literal expression of the policy, but also its intent. By signing this affirmation of compliance, I hereby affirm that I understand and agree to comply with the Conflict of Interest Policy. I further understand that Lake Washington Saddle Club is a nonprofit organization and that in order to maintain its federal tax exemption it must engage primarily in activities that accomplish one or more of its tax-exempt purposes without personal inurement or benefit by board members., consultants/volunteers or staff (other than by salary). I hereby state that I do not have any conflict of interest, financial or otherwise that may be seen as competing with the interests of Lake Washington Saddle Club, nor does any relative or associate have such a potential conflict of interest. If any situation should arise in the future that I think may involve me in a conflict of interest, I will promptly and fully disclose in writing the circumstances to the President of the Board of Directors. I further certify that the information set forth in the Disclosure Statement and attachments, if any, is true and correct to the best of my knowledge, information and belief.

* Indicates required field

Date (MM/DD/YYYY) *

Name of Board Member *

First

Last

Has Lake Washington Saddle Club proposed to contract or contracted to purchase or lease goods, services, or property from you or from any of your relatives or associates? *

Yes No

Have you used your relationship with LWSC to obtain a contract, employment for yourself or any of your relatives or associates, from a person or entity that does business with LWSC? *

Yes No

Have you or any of your relatives been provided use of the facilities, property, or services of LWSC in a way that is not available to others who benefit from the organization’s services? *

Yes No

Have you, a relative or an associate been in a position to benefit financially from an action, policy or transaction made by LWSC? *

Yes No

Comment *

Submit

To download or print the Conflict of Interest Policy, you can access a pdf version below.

Annual Conflict of Interest Form