A23 Attach 7 OCI Analysis and Disclosure Form.docx
DOCX document 15 KB Posted
- Solicitation number
- HQ003420R0089
- Issued by
-
DOD Washington Headquarters Service
About this file
This document contains an Organizational Conflict of Interest (OCI) Analysis and Disclosure Form template and instructions for its completion. The form is to be used by contractors bidding on the Office of the Secretary of Defense (OSD) Analytic & Technical Support Services (ATSS) Indefinite-Delivery/Indefinite-Quantity (IDIQ) recompete, with requirements coming primarily from the Under Secretary of Defense Acquisition and Sustainment (USD A&S). Contractors must disclose any potential or actual OCIs by completing a separate form for each existing USD A&S-related contract, providing details of the work performed, its relationship to the new opportunity requirements, and a summary of and plans to mitigate any OCIs. The IDIQ will encompass administrative management and general management consulting as well as professional, scientific, and technical services support, primarily within the National Capital Region including the Pentagon and Mark Center.
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Other files
| File | Type | Posted |
|---|---|---|
| A23 Attach 12 RFP QA Amendment 3.pdf | ||
| A23 RFP HQ003420R0089 Amend 3.pdf | ||
| A23 Attach 11 RFP QA Amendment 2.pdf | ||
| A23 RFP HQ003420R0089 Amend 2.pdf | ||
| A23 Attach 6 Past Performance Questionnaire Amd 1.doc | DOC document | |
| A23 Attach 1 Small Business Participation Commitment Document Amd 1.docx | DOCX document | |
| A23 Attach 4 Subcontracting Plan Amd 1.docx | DOCX document | |
| A23 RFP HQ003420R0089 Amend 1.pdf | ||
| A23 Attach 10 RFP QA.pdf | ||
| A23 Attach 8 ATSS Historical Environment Document.pdf | ||
| A23 Attach 4 Subcontracting Plan.docx | DOCX document | |
| A23 Attach 3 FP and TM-LH Labor Category Pricing Worksheet.xls | XLS spreadsheet | |
| A23 Attach 1 Small Business Participation Commitment Document.docx | DOCX document | |
| A23 RFP HQ003420R0089.pdf | ||
| A23 Attach 6 Past Performance Questionnaire.doc | DOC document | |
| A23 Attach 5 Accounting System Checklist.doc | DOC document | |
| A23 Attach 2 FP Labor Category Pricing Worksheet.xls | XLS spreadsheet | |
| A23 Attach 9 QA from Draft RFP.pdf |
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Text version
OCI ANALYSIS/ DISCLOSURE FORM
1. Contract Number
HQ0034-XX-R-XXXX
2. Program Title
ATSS IDIQ-R
3. Contractor Name and Address
4. Telephone Number and POC
5. Type of work to be performed under this agreement:
| Other [insert customer such as USD A&S]-related work requiring analysis and determination: |
| 6. Contract Number and Program Title |
7. Brief Summary/ Description of work performed under Block 6 action:
8. Relationship between requirements of Block 1 action and work performed under Block 6 action (If None, State Why):
9. Offeror/Contractor OCI Evaluation and Assessment (If either answer is yes, attach a copy of the PWS and complete Block 10):
1. Does Actual OCI exist? ( ) Yes ( ) No
1. Does Potential OCI exist? ( ) Yes ( ) No
10. Summary of actual/potential OCI, including actions planned to avoid, neutralize, or mitigate conflict or potential conflict:
11. Typed Name of Responsible Official
12. Signature
13. Date
14. Typed Name of Contracting Officer
15. Approval Signature
16. Date
INSTRUCTIONS FOR COMPLETING OCI ANALYSIS/ DISCLOSURE FORM
Blocks 1 through 5: Self explanatory
Block 6: Fill in the number and the short, official title by which the contract or subcontract requiring analysis and determination is formally known. This is work that has already been awarded, is being performed by your company, and requires a comparison with the work described in Blocks 1 – 5. NOTE: One OCI Analysis/ Disclosure Form shall be submitted for EACH [INSERT USD A&S])–related contract or subcontract currently being performed.
Block 7: Provide a brief, but specific, narrative summary of the PWS and work performed on the contract or subcontract listed in Block 6, including the period of performance and the value.
Block 8: Provide a brief, but specific, narrative summary of ANY relationship between the work to be performed under the action listed in Block 1 and the previous work performed under the action listed in Block 6. Please be as specific as possible by citing the specific RFP/PWS paragraph where possible.
Block 9: Place an “X” in the appropriate ( ) for your responses.
Block 10: If you answer yes to either 9(a) or to 9(b), provide a summary of the actual or potential OCI.
Blocks 11, 12, and 13: Provide the name of your company official with the responsibility for and/or authority to discuss and commit the company on matters related to OCI issues. That official should then sign and date each form.
File details come from the government source that posted it. Updated .