In accordance with SERC’s Bylaws, the Amended and Restated SERC Delegation Agreement, and IRS Form 990, each Director and Alternate must act in accordance with SERC’s Conflict of Interest and Business Ethics Policy and sign an acknowledgement thereof. IRS Form 990 also requires an additional disclosure about the existence of Family and Business relationships between officers, directors, or key employees.  If you have any questions about SERC’s Conflict of Interest and Business Ethics Policy or this acknowledgement, please contact SERC’s General Counsel. 

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* 1. I hereby acknowledge that I have read and agree to abide by the SERC Conflict of Interest and Business Ethics Policy for SERC Representatives.

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* 2. Print Name

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* 3. Company Name

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* 4. Date

Date

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* 5. List entities, including your own employer if applicable, under SERC Reliability Corporation jurisdiction for which a Conflict may exist with respect to participation in actions or decisions as a director of SERC Reliability Corporation: (Write “NONE” if there are no conflicts.)

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* 6. Indicate whether or not you have a family or business relationship with any other SERC director, officer, or employee.

If you respond yes, you will be contacted to provide more detail on the relationship.

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