Attachment 4 OCI Disclosure and Analysis Form.docx
DOCX document 31 KB Posted
- Solicitation number
- FA252126Q0010
About this file
This is an Organizational Conflict of Interest (OCI) Disclosure and Analysis Form template designed for use in the SPLASH (Spaceport and Launch Assessment & Strategic Help) solicitation.
The form serves as a required disclosure document for contractors bidding on this Foreign Military Sales (FMS) technical services contract. It is structured to capture potential conflicts of interest that may arise from a contractor's past, present, or proposed business relationships, affiliations, or activities that could compromise their objectivity or create unfair competitive advantages. The form requires contractors to identify any relationships with other contractors, government agencies, or entities involved in the SPLASH requirement; describe the nature and scope of those relationships; assess the level of OCI risk; and propose mitigation strategies if conflicts are identified. Contractors must certify the accuracy and completeness of their disclosures. This form is essential for the Department of the Air Force Space Command to evaluate whether a contractor can perform the work impartially and in the government's best interest, particularly given the sensitive nature of supporting a Partner Nation's National Security Space Launch capability development at a sovereign spaceport using commercial launch vehicles. Submission of an accurate and complete OCI disclosure is a prerequisite for proposal acceptance.
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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): Immediately to the right of each box for the types of work where you believe conflicts of interest, real or perceived, exist, list the USSF contract/subcontract numbers with titles needing analysis and a Contracting Officer determination.
Block 5: Provide brief summaries of the work performed under the contract/subcontract(s) listed in Block 4. 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 |
| FA2521-26-Q-0010 |
| Spaceport Launch Assessment & Strategic Help (SPLASH) Contract |
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 of interest for your company:
a. CLIN 0001 CDRL A01 – General Launch Vehicle Assessment Report
b. CLIN 0002 CDRL A02 – Spaceport Assessment and National Security Space Launch Requirements Document
c. CLIN 0003 CDRL A03 – National Security Space Launch Requirements and LRV Process Report
d. CLIN 0004 CDLR A04 – Recommended Education and Training Documentation
e. CLIN 0005 CDRL A05 – Comprehensive Assessment and Recommendations Report and Briefing
f. CLIN 0006 CDRL A06 – Meeting agendas, minutes, invites, and action items
g. CLIN 0007 Travel Budget
h. Having potential access to Proprietary Information of Others as part of performance of this contract
i. Reviewing/Preparing Designs, Reports, Plans or Specifications, or providing other similar Advisory and Assistance type support to the US Government or Partner Nation as part of this contract
j. Working on, alongside, or with other contracts/contractors, foreign or domestic, in support of these requirements
k. Any other SOW areas and/or contract performance required not identified in items a. thru j. above
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 .