ATTM 006.docx
DOCX document 25 KB Posted
- Attached to
- CAHPS SURVEY
- Solicitation number
- 5400028011
- Issued by
- Richland County, South Carolina
About this file
This is an Organizational Conflict of Interest Disclosure form issued by the State of South Carolina, requiring offerors to disclose any potential conflicts of interest related to contract work. The document outlines the state's policy to avoid situations where an offeror's judgment may be biased due to past, present, or planned interests that could affect their work performance or provide unfair competitive advantages.
The form requires offerors to provide detailed narrative statements about any relevant financial, contractual, or organizational interests that could create conflicts, along with potential mitigation strategies. The State reserves the right to impose conditions, disqualify offerors, or take other actions based on the disclosed information. Failure to provide required disclosures or misrepresentation of interests can result in disqualification from award or contract termination. The form includes sections for a disclosure statement, representation certification, and signature blocks where offerors must formally acknowledge their compliance.
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Other files
| File | Type | Posted |
|---|---|---|
| Award Posting Notice 1.pdf | ||
| Ext of Award Posting.pdf | ||
| A2 CAHPS SURVEY.pdf | ||
| A1 CAHPS SURVEY.pdf | ||
| ATTM 010 Q&A.pdf | ||
| ATTM 003t.docx | DOCX document | |
| ATTM 004.docx | DOCX document | |
| CAHPS SURVEY.pdf | ||
| ATTM 002.docx | DOCX document | |
| ATTM 009.xlsx | XLSX spreadsheet | |
| PL-002.docx | DOCX document | |
| ATM 001.docx | DOCX document | |
| PL-001.pdf | ||
| ATTM 005.pdf | ||
| ATTM 007.docx | DOCX document | |
| ATTM 008.xlsx | XLSX spreadsheet |
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Text version
Organizational Conflict of Interest Disclosure
| I. | INSTRUCTIONS | ||
| Read Part II carefully. If a disclosure statement is required, please provide a narrative statement in Part III. If a representation is submitted, please complete Part IV. Complete Part V in every case. | |||
| II. | ORGANIZATIONAL CONFLICT OF INTEREST DISCLOSURE OR REPRESENTATION | ||
| It is the policy of State of South Carolina (State) to avoid situations which place an Offeror in a position where its judgment may be biased because of any past, present, or currently planned interest, financial or otherwise, the Offeror may have which relates to the work performed pursuant to this solicitation or where the Offeror’s performance of such work may provide it with an unfair competitive advantage. (As used herein “Offeror” means the proposer or any of its affiliates or proposed consultants or subcontractors of any tier.) | |||
| Therefore: | |||
| (a) | The Offeror shall provide a statement which describes in a concise manner all relevant facts concerning any past, present or currently planned interest (financial, contractual, organizational, or otherwise) relating to the work to be performed hereunder and bearing on whether the Offeror has a possible organizational conflict of interest with respect to (1) being able to render impartial, technically sound, and other objective assistance or advise, or (2) being given an unfair competitive advantage. The Offeror may also provide relevant facts that demonstrate how possible organizational conflict of interest relating to other divisions or sections of the organization(s) or its existing organizational structure or system might be avoided or mitigated. This information should be provided in narrative form in Part III. | ||
| (b) | In the absence of any relevant interest referred to above, the Offeror shall submit a statement certifying that to its best knowledge and belief no such facts exist relevant to possible organizational conflicts of interest. The Offeror’s statement pursuant to this paragraph as well as any statement required to be submitted under (a) above shall include statements form proposed consultants and subcontractors at any tier if relevant. Offeror is responsible for submitting all such information as part of its certification. | ||
| (c) | The State will review the statement submitted and may require additional relevant information from the Offeror. All such information, and any other relevant information will be used by State to determine whether an award to the Offeror may create an organizational conflict of interest. If found to exist, State may (1) impose appropriate conditions which avoid such conflict, (2) disqualify the Offeror, or (3) determine that it is otherwise in the best interest of the State to contract with the Offeror by including appropriate conditions mitigating such conflict in the contract awarded. | ||
| (d) | The refusal to provide the disclosure or representation of any additional information as required shall result in disqualification of the Offeror for award. The nondisclosure or misrepresentation of any relevant interest may also result in the disqualification of the Offeror for award, or if such nondisclosure or misrepresentation is discovered after award, the State may terminate the contract for default, disqualify the contractor from subsequent related contracts, or subject the contractor to such other remedial actions as may be permitted or provided by law. | ||
| (e) | No award shall be made until the disclosure or representation has been evaluated by State. |
III. DISCLOSURE STATEMENT: (attach additional pages if more space is needed)
(Offeror to provide a concise narrative of any potential conflicts)
IV. REPRESENTATION
The Offeror, ___________________________________________________, hereby represents that it is aware of no past, present, or currently planned interest (financial, contractual, organizational, or otherwise) relating to the work to be performed under the contract resulting from Request for Proposal No. __________________________ that would indicate any impingement upon its ability to render impartial, technically sound, and objective assistance or advice or result in it being given an unfair competitive advantage. This representation applies to all affiliates of the Offeror and its proposed consultants or subcontractors of any tier.
V. SIGNATURE
| Offeror’s Name___________________________________________________________________ |
| RFP/Contract No. RFP 54000XXXXX |
| Signature___________________________________________________________________ |
| Title_______________________________________________________________________ |
Date_______________________________________________________________________
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