ATTM 006.pdf
PDF 92 KB Posted
- Attached to
- MEDICAID CLINICAL DATA EXCHANGE
- Solicitation number
- 5400030026
- 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 for Request for Proposal No. 5400026974. The form requires offerors to disclose any past, present, or currently planned interests—financial, contractual, organizational, or otherwise—that could create conflicts of interest or provide unfair competitive advantages in performing the work under the solicitation. Offerors must provide detailed narrative statements describing relevant facts concerning their interests and how potential conflicts might be avoided or mitigated. The disclosure requirement applies to the primary offeror as well as all affiliates, proposed consultants, and subcontractors at any tier.
The State of South Carolina reserves the right to review all submitted disclosures and request additional information as needed to evaluate whether an award would create an organizational conflict of interest. If conflicts are identified, the State may impose conditions to mitigate them, disqualify the offeror, or proceed with the award if determined to be in the State's best interest. Failure to provide the required disclosure or representation, nondisclosure of relevant interests, or misrepresentation of facts may result in disqualification from award or, if discovered post-award, contract termination for default, disqualification from future related contracts, or other remedial actions permitted by law. No award will be made until the disclosure has been evaluated by the State.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 1.pdf | ||
| Amendment 2.pdf | ||
| PL 001.pdf | ||
| ATTM 003.pdf | ||
| ATTM 005.pdf | ||
| PL 005.pdf | ||
| ATTM 025.pdf | ||
| ATTM 019.pdf | ||
| ATTM 013.xlsx | XLSX spreadsheet | |
| ATTM 004.pdf | ||
| ATTM 018.pdf | ||
| ATTM 023.pdf | ||
| PL 004.pdf | ||
| ATTM 017.pdf | ||
| ATTM 010.pdf | ||
| PL 002.pdf | ||
| ATTM 002.pdf | ||
| ATTM 007.pdf | ||
| ATTM 022(b).xlsx | XLSX spreadsheet | |
| ATTM 020.pdf | ||
| ATTM 009.xlsx | XLSX spreadsheet | |
| ATTM 022(a).pdf | ||
| _MCDE RFP.pdf | ||
| ATTM 015.pdf | ||
| ATTM 024.pdf | ||
| PL 003.pdf | ||
| ATTM 001.pdf | ||
| ATTM 008.xlsx | XLSX spreadsheet | |
| ATTM 014.pdf | ||
| ATTM 012.xlsx | XLSX spreadsheet | |
| ATTM 011.pdf | ||
| ATTM 021.pdf | ||
| ATTM 016.pdf |
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Text version
ATTM 006 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. 5400026974 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. ____________________________________________________________ Signature___________________________________________________________________ Title_______________________________________________________________________ Date_______________________________________________________________________
ATTM 006 Organizational Conflict of Interest Disclosure
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