Attachment 10 - OCC Conflict of Interest Disclosure and Certification.docx

Attachment 10 – OCC Conflict of Interest Disclosure and Certification Solicitation # 2031JW21Q00092

1052.209-8001 Conflict of Interest Disclosure and Certification (FEB 2014)

(a) The contractor, subcontractor, employee, or consultant, by signing (b) in this provision, certifies that, to the best of its knowledge and belief, there are no relevant facts or circumstances that could give rise to an organizational or personal conflict of interest, (see FAR Subpart 9.5 for organizational conflicts of interest) or apparent conflict of interest, for the organization or any of its staff.

(b) Conflict of Interest Certification.

The offeror, [insert name of offeror], hereby certifies that, to the best of its knowledge and belief, there are no present or currently planned interests (financial, contractual, organizational, or otherwise) relating to the work to be performed under the contract or task order resulting from Request for Quotation No. 2031JW21Q00092 that would create any actual or potential conflict of interest (or apparent conflicts of interest) (including conflicts of interest for immediate family members: spouses, parents, children) that would impinge on its ability to render impartial, technically sound, and objective assistance or advice or result in it being given an unfair competitive advantage. In this provision, the term “potential conflict” means reasonably foreseeable conflict of interest. The offeror further certifies that it has and will continue to exercise due diligence in identifying and removing or mitigating, to the Government's satisfaction, such conflict of interest (or apparent conflict of interest).

Offeror's Name____________________ RFP/RFQ No.____________________ Signature____________________ Title____________________ Date____________________

(c) If the prospective Contractor cannot so certify, it shall provide a disclosure statement in its proposal with the potential organizational conflict of interest. The statement must contain the following:

1) Name of the agency and the number of the solicitation in question.

2) The name, address, telephone number, and federal taxpayer identification number of the apparent successful offeror.

3) A description of the nature of the services rendered by or to be rendered on the instant contract.

4) A statement of any past (within the past twelve months), present, or currently planned financial, contractual, organizational, or other interests relating to the performance of the statement of work. For contractual interests, such statement must include the name, address, telephone number of the client or client(s), a description of the services rendered to the previous client(s), and the name of a responsible officer or employee of the offeror who is knowledgeable about the services rendered to each client, if, in the 12 months preceding the date of the statement, services were rendered to the Government or any other client (including a foreign government or person) respecting the same subject matter of the instant solicitation, or directly relating to such subject matter. The agency and contract number under which the services were rendered must also be included, if applicable. For financial interests, the statement must include the nature and extent of the interest and any entity or entities involved in the financial relationship. For these and any other interests enough such information must be provided to allow a meaningful evaluation of the potential effect of the interest on the performance of the statement of work.

(d) Prospective Contractors should refer to FAR subpart 9.5 for policies and procedures for avoiding, neutralizing, or mitigating organizational conflicts of interest.

(e) If the Contracting Officer determines that a potential conflict exists, the prospective Contractor shall not receive an award unless the conflict can be avoided or otherwise resolved through the inclusion of a special contract clause or other appropriate means. The terms of any special clause are subject to negotiation.

(End of Provision)