Attachment 9 OCI Disclosure and Analysis Form.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- Advisory & Assistance Services & Systems Engineering & Technical Assistance Services for Headquarters, Air Force Space Command Federal contract opportunity
- Solicitation number
- FA2517-08-R-9000
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Attachment 9 OCI Disclosure and Analysis Form
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| 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.xls". This form must be submitted in Microsoft Excel to the Contracting Officer. 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 AFSPC 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 AFSPC or another contractor for use within AFSPC | |||
| f. AFSPC Contracts/AFSPC 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: |
&"-,Bold"AFSPC OCI Disclosure and Analysis Form&"-,Regular"
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