Atch16 - OCI Declaration and Disclosure.docx
DOCX document 54 KB Posted
- Attached to
- Program Executive Office (PEO) Defense Healthcare Management Systems (DHMS) Deployment Solutions
- Solicitation number
- HT003826RE001
- Issued by
-
Defense Health Agency
About this file
This file is an Organizational Conflict of Interest (OCI) Declaration and Disclosure Statement template required for the PEO DHMS Deployment Solutions solicitation (HT003826RE001). The template is designed to be completed by all offerors to certify whether they have any organizational conflicts of interest that would disqualify them from competing for this procurement opportunity issued by the Defense Health Agency. The document requires an authorized company representative to declare either that the company and its team entities (including affiliates, subsidiaries, joint venture partners, subcontractors, consultants, and vendors) have no OCI—meaning they have not accessed non-public information regarding the solicitation or provided prior government services that would influence competition—or to disclose relevant information if a potential conflict exists.
Failure to complete and submit this statement or providing omitted or misrepresented information may result in ineligibility for award. If an offeror cannot make a clear OCI declaration, it must provide a detailed disclosure statement identifying the company, relevant government agency, contract number, dates of activity, complete facts bearing on the potential conflict, and any mitigation plans for government consideration. The statement requires the signature, typed name, title, and date of the authorized representative and company name. This template is part of the pre-solicitation phase issued for industry review and comment, with formal proposal solicitation expected at a later date.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
HT003821R0001CUI//PROCURE
CUI//PROCURE
HT003826RE001CUI//PROCURE
Program Executive Office (PEO) Defense Healthcare Management Systems (DHMS) Deployment Solutions
Attachment 16: Organizational Conflict of Interest Declaration and Disclosure
Solicitation Number: HT003826RE001 Program Executive Office, Defense Healthcare Management Systems (PEO DHMS)
BACKGROUND
It is the Government’s intent to vet all offerors to ensure they do not have Organizational Conflicts of Interest such that the Government must disqualify an offeror from competing for this procurement. Please refer to Revolutionary Federal Acquisition Regulation (FAR) Overhaul (RFO) 9.5. To that end, the Government requires that each offeror complete the following Organizational Conflict of Interest Declaration and Disclosure Statement.
OFFEROR’S OCI DECLARATION AND DISCLOSURE
Failure to provide the enclosed Organizational Conflict of Interest Declaration and Disclosure Statement, or omitting or misrepresenting information on the Statement, may result in the offeror being determined ineligible for award.
The undersigned, (Insert Name)_____, an authorized representative of ___(Insert Company Name)_____, (which is hereinafter referred to the “Company”), declares that my Company, including any entity[footnoteRef:1] on my team, to the best of my knowledge and belief, does not have an Organizational Conflict of Interest regarding solicitation HT003826RE001 as my Company has not: 1) had access to non-public information regarding solicitation HT003826RE001 that would assist my Company in obtaining the contract resulting from the solicitation, and 2) has not provided services under any Government contract that put my company in a position to influence the competition under solicitation HT003826RE001. [1: An Entity shall include the offeror, its affiliates and subsidiaries, joint venture partners, subcontractors, consultants, and vendors.]
-OR-
The undersigned, (Insert Name)_____, an authorized representative of ___(Insert Company Name)_____, (which is hereinafter referred to the “Company”) cannot declare that my Company, including any entity1 on my team, does not have an Organizational Conflict of Interest regarding solicitation HT003826RE001, as my Company does have information that is likely relevant to the Government’s assessment of whether my Company has an Organizational Conflict of Interest. Therefore, I have provided a disclosure statement[footnoteRef:2] attached to this form which describes all relevant information bearing on whether my Company may have an Organizational Conflict of Interest regarding solicitation HT003826RE001 [2: The document will identify the company, Governmental agency, contract number, dates of activity, the complete facts relevant to the potential type of conflict, mitigation plans, or other pertinent information for the Government’s consideration and review.]
SIGNATURE
[Company’s Name] [Authorized Representative’s Typed Name] [Title] [Date]
CUI//PROCURE
File details come from the government source that posted it. Updated .