ACR Project Specific Verifier Conflict of Interest Form

							                             American Carbon Registry
    Validation/Verification Body Project-Specific Conflict of Interest Attestation

 Before performing any validation and/or verification services for ACR project proponents or
 inventory members, ACR-approved Validation/Verification Bodies (V/VB) are required to
 complete and submit this project-specific conflict of interest attestation. Completed forms
 should be sent to verification@americancarbonregistry.org.


Name of Validation/Verification Body (V/VB)

Name of project proponent/corporate inventory member
seeking validation/verification services from V/VB
Name of project/corporate inventory for which
validation/verification services are requested
Date project-specific COI form submitted to ACR


 As agreed to in the “Attestation of Verification Body”:

 The ACR-approved V/VB will not conduct validation and/or verification with respect to any ACR
 project or corporate inventory where the V/VB or any member of the validation/verification
 team has a financial interest in the project or corporation, has played a role in developing the
 project or has any other conflict of interest. (Absent unusual circumstances, validating a
 monitoring or verification protocol and/or serving as a member of a scientific peer review
 process does not constitute having a role in developing a project.)

 Without limiting the foregoing, the V/VB will not conduct validation/verification with respect to
 a project or corporate inventory if an independent observer could reasonably conclude that
 current or prior personal or business relationships between the V/VB or its team member(s)
 and the project, project proponent or corporation present a conflict of interest.

 Please complete the following:

 1. Describe all relationships in the last three years between the V/VB (and its affiliate
    organization(s), if applicable) and validation/verification team members, on the one hand,
    and the project, project proponent or corporate inventory being verified, on the other. If
    any of these past or current relationships involve affiliate organization(s) of the V/VB please
    describe the connection.




             Empowering the disadvantaged, increasing economic opportunity, and sustaining natural resources.
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2. Describe the procedures and structures in place within the ACR-approved V/VB to identify
   and prevent/mitigate any potential or actual conflicts of interest.



3. Describe all potential conflicts of interest that may result in the V/VB providing
   validation/verification services to the project proponent/corporate inventory member.



4. List all staff and/or contractors of the ACR-approved V/VB who may provide
   validation/verification services to this project proponent/corporate inventory member.



Attestation:
We hereby attest that:
   a. Neither the ACR-approved V/VB nor any member of the validation/verification team has
       a conflict of interest with respect to this proposed work;
   b. All potential conflicts of interest have been identified and there are structures and
       processes in place to successfully avoid or mitigate them;
   c. All information provided in this form is accurate to the best of our knowledge;
   d. We will maintain the accuracy and completeness of the information contained herein by
       notifying ACR in writing to verification@americancarbonregistry.org of any material
       change.

In witness whereof, the V/VB and ACR Project Proponent/Corporate Inventory Member have
caused this Attestation to be executed by duly authorized representatives as of the dates set
forth below.
______________________________________ ______________________________________
ACR-Approved V/VB                                ACR-Project Proponent/Corporate Inventory

______________________________________                      ______________________________________
Signature of Lead Verifier                                  Signature of representative

______________________________________ ______________________________________
Print Name                             Print Name

______________________________________ ______________________________________
Title                                  Title


           Empowering the disadvantaged, increasing economic opportunity, and sustaining natural resources.
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______________________________________ ______________________________________
Date                                   Date




         Empowering the disadvantaged, increasing economic opportunity, and sustaining natural resources.
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