J.15 ORGANIZATIONAL CONFLICT OF INTEREST (OCI) STATEMENT.docx

Attachment J.15 RFP #: 7200AA22R00037

ANNUAL ORGANIZATIONAL CONFLICT OF INTEREST (OCI) CERTIFICATION AND DISCLOSURE

The Offeror/Contractor hereby certifies, to the best of its knowledge, including the knowledge of its agents and subcontractors, that:

_____ (1) There are no facts, information or circumstances which create any actual or the appearance of a potential significant organizational conflict of interest. The basis of this determination is explained as follows:

(Provide explanation)

_____ (2) The Offeror/Contractor is aware of the existence of an actual or the appearance of a potential significant organizational conflict of interest.

If there is an existing or potentially significant OCI, then the Offeror/Contractor is required to disclose this information to the Contracting Officer specified in Section G.4. The Mitigation Plan shall identify and address the following:

· An overview of the OCI issue(s);

· Identify if the OCI solely impacts the prime contractor, or if the OCI is in relation to any subcontractor;

· A mitigation plan that addresses -

· Risk assessment that details how the OCI could impact the deliverables under the contract;

· The strategy to manage, avoid or neutralize the OCI;

· How long the Offeror/Contractor proposed implementation of the plan will take; and

· Who is responsible for surveillance and enforcement of the plan.

OTHER RELEVANT INFORMATION: In addition to the mitigation plan proposed above, the Contracting Officer may require further relevant information from the Offeror/Contractor in accordance with I.20 AIDAR 752-209-71 and H.14. The Contracting Officer will use all information submitted by the Offeror/Contractor, in addition to other relevant information made known or available to USAID, to determine whether the mitigation plan will adequately avoid or mitigate the conflict (see FAR 9.506(a)).

NOTIFICATIONS: The Offeror/Contractor shall inform the Contracting Officer within forty-five (45) calendar days from the date of discovery of any new OCI pursuant to Section I.20 AIDAR 752-209-71, and/or any changes in circumstance that may affect any contracting officer approved mitigation plan (see FAR 752.209-71).

Name:

Title:

Organization:

Date: _____________________