Attachment 5 - OCI Disclosure and Analysis Form.docx
DOCX document 28 KB Posted
- Attached to
- Buckley SFB Integrated Solid Waste Management Federal contract opportunity
- Solicitation number
- FA254323Q0040
About this file
This document contains an Organizational Conflict of Interest (OCI) Disclosure and Analysis Form template to be completed by companies responding to Solicitation Number FA254323Q0040 for integrated solid waste management services at Buckley Space Force Base. The form requires disclosure of potential OCIs for areas of work including systems engineering, technical direction, specifications preparation, technical evaluation, proprietary information access, and product provision to the Department of the Air Force or other contractors. Companies must summarize any current or prior contracts potentially giving rise to an actual or perceived OCI, and describe proposed mitigation actions if an OCI is identified. The solicitation is issued by the Department of the Air Force Space Command for integrated solid waste management at Buckley Space Force Base, with no further details provided on response dates, award timing, or pricing terms.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Responses to Questions 12-19-2023.pdf | ||
| Attachment 4 - Pricing Sheet Template.xlsx | XLSX spreadsheet | |
| Attachment 2 - ISWM PWS FINAL 26 October 2023.pdf | ||
| Attachment 1 - Instructions and Basis of Award.pdf | ||
| Attachment 3 - Questions Template.xlsx | XLSX spreadsheet | |
| Attachment 6 - Wage Determination 2015-5419.pdf | ||
| Solicitation - FA254323Q0040 (2).pdf |
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
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 DAF 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 DAF or another contractor for use within DAF
f. DAF Contracts/DAF 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 .