Attachment 4 - OCI Disclosure and Analysis Form.docx
DOCX document 28 KB Posted
- Attached to
- USAFA FOIA Support
- Solicitation number
- FA70007182024
About this file
This document is an Organizational Conflict of Interest (OCI) Disclosure and Analysis Form. It is used to identify and disclose potential OCI issues related to a specific USSF contract or subcontract.
The form instructs the company to indicate the types of work that could create a conflict of interest, provide a summary of the work performed under the applicable contracts, and assess whether an actual or potential OCI exists. If a conflict is identified, the company must describe the OCI and proposed mitigation actions. The form is required to be submitted for each functional area or sub-area needing OCI analysis and a Government determination.
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Other files
| File | Type | Posted |
|---|---|---|
| FOIA PWS 20June24.pdf | ||
| Attachment 3 - Provisions and Clauses (1).docx | DOCX document | |
| FOPR FOIA v2 CO Signed.pdf | ||
| Attachment 2 -Staffing Approach Table.xlsx | XLSX spreadsheet |
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Text version
USSF
OCI Disclosure and Analysis Form
Instructions: Use the "Tab" key and /or mouse pointer to navigate this form. Upon completing this form save using the following name format: "OCI-Company Name or Abbreviation". Reference solicitation for guidance on use and submittal of this form.
NOTE: Submit one OCI Disclosure and Analysis Form for EACH functional area or sub-area requiring analysis and a Government OCI determination.
Blocks 1 - 3: Self Explanatory
Block 4(a-f): Place an "X" in the appropriate box for the types of work where you believe conflicts of interest, real or perceived, exist. Immediately to the right, list the USSF contract/subcontract numbers with titles needing analysis and a Contracting Officer determination.
Block 4: Provide brief summaries of the work performed under the contract/subcontract(s) listed in Block 5. Include the period of performance and the total contract value.
Block 6: Circle applicable statement if you believe an OCI exists - If neither is believed to exist, there is no need to submit this form.
Block 7: If you circle either statement in Block 6, provide a description of the OCI and proposed mitigation actions to avoid or neutralize the conflict. (May be submitted as an attachment to this form.)
| 1. Solicitation/Contract Number: |
| 2. Program Title |
3. Your Company's Name, Address, and POC:
a. Company Name
b. Address
c. City
d. State
e. Zip Code
f. POC Name
g. Phone
h. POC E-mail
4. Areas of work that could cause a conflict for your company (complete only one area per form):
a. Providing Systems Engineering and Technical Direction
b. Preparing Specifications or Work Statements
c. Providing Technical Evaluation or Advisory & Assistance Services
d. Access to Proprietary Information of Others
e. Providing products, hardware, or software to USSF or another contractor for use within USSF
f. USSF Contracts/USSF Funded Contracts
5. Summary/Description of work performed under contracts identified in Block 4:
6. OCI Evaluation and Assessment:
| Actual OCI Exists |
| Potential for OCI exists |
7. Descriptive summary of each actual/potential OCI, including mitigation actions planned to avoid or neutralize the conflict:
File details come from the government source that posted it. Updated .