Attachment 02 OCI Analysis Disclosure Form.docx
DOCX document 13 KB Posted
- Attached to
- RDT&E Research, Engineering, and Technical Services (RETS) IDIQ Federal contract opportunity
- Solicitation number
- HQ003420R0129
- Issued by
- DOD Washington Headquarters Service
About this file
This document contains an attachment template for analyzing and disclosing potential organizational conflicts of interest related to a federal contract opportunity. The template requests information including the contract and program names, contractor details, a summary of work performed under current and proposed efforts, and an assessment of whether an actual or potential conflict of interest exists between the two efforts. If an actual or potential conflict is found, the template requires a summary and description of actions planned to avoid, neutralize, or mitigate the conflict. A responsible official from the contractor's organization must sign and date a completed version of the disclosure form for each existing contract being assessed.
The related federal contract opportunity is a multiple-award IDIQ solicitation from the Washington Headquarters Services on behalf of the Office of the Undersecretary of Defense for Research and Engineering. The IDIQ aims to establish a pool of at least two small business awardees to support OUSD(R&E)'s mission through the provision of research, engineering, and technical services.
View the file
Other files for this federal contract opportunity
Show all 18
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment – 2 – OCI Analysis Disclosure Form
1. Contract Number
2. Program Title RDT&E Technical Support (RETS) IDIQ
3. Contractor Name and Address
4. Telephone Number & POC
5. Type of work to be performed under this agreement:
6. Contract Number and Program
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 SOW and complete Block 10):
Does Actual OCI exist? ( ) Yes ( ) No 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 related contract or subcontract currently being performed.
Block 7: Provide a brief, but specific, narrative summary of the SOW 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/SOW 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.
(End of Clause)
File details come from the government source that posted it. Updated .