Atch_11_-_COI_Statements.docx
DOCX document 98 KB Posted
- Attached to
- Optimizing Human Weapon System (OHWS) Federal contract opportunity
- Solicitation number
- FA4890-18-R-5035
About this file
This document contains a federal contract solicitation for Optimizing Human Weapon System services. The Air Force seeks proposals for a firm fixed price contract to provide prehabilitation services to decrease neck and back pain in aircrew. The base period is one year with four one-year options. The total period of performance is five years from March 2020 to September 2025. This is a 100% small business set-aside with a NAICS code of 621340. Offerors must register in SAM and use WAWF for invoicing. Questions are due by August 23rd and proposals are due September 16th. The contact information provided is for the Contracting Officer and Contract Manager.
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DEPARTMENT OF THE AIR FORCE
HEADQUARTERS AIR COMBAT COMMAND
ACQUISITION MANAGEMENT AND INTEGRATION CENTER
JOINT BASE LANGLEY-EUSTIS VA
CONFLICT OF INTREST STATEMENT
COMBAT AIR FORCES (CAF)
OPTIMIZING THE HUMAN WEAPON SYSTEM (OHWS) SERVICES
FA4890-18-R-5035
Please review the list of prime contractors and their subcontractors who are offering proposals in response to the Request for Proposal (RFP) for the acquisition identified above. After reviewing the list, check the appropriate boxes, fill in the information requested, and sign:
I certify that neither I nor my immediate family, to the best of my knowledge, possess any financial interest whatsoever in any company, parent or subsidiary, which is proposing on the acquisition identified above now being considered by the Source Selection Evaluation Board (SSEB) of which I am a member or advisor. Should any company in which I or my immediate family has a financial interest submit a proposal to my source selection team, I will reveal immediately such interest to the SSEB Chairperson and the Contracting Officier. (Please note that ownership of a financial interest in a company described in this paragraph which interest is valued at less than $15,000 is not disqualifying and need not be reported on this form. The $15,000 value is additive among your spouse and minor children, if any.)
OR
I do possess a financial interest in a company that is proposing on or is in a way involved in the acquisition identified above now being considered by the SSEB of which I am a member or advisor. (If you have checked this box, please provide a description of your financial interests on the reverse side of this form.)
I further acknowledge my obligation to disclose any friendships; family or social relationships; past, present, or planned employment relationships, or any other type of relationship, such as housing or transportation arrangements, which might be perceived as compromising my independent judgment in connection with this Source Selection. (Please make any disclosures on the reverse of this form.)
Name (print):
Organization: Phone:
Signature:
Date:
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