Organizational Conflict of Interest (OCI) Declaration and Disclosure.docx
DOCX document 55 KB Posted
- Attached to
- Program Executive Office (PEO) Defense Healthcare Management Systems (DHMS) Deployment Solutions
- Solicitation number
- HT003826RE001
- Issued by
-
Defense Health Agency
About this file
This is an Organizational Conflict of Interest (OCI) Declaration and Disclosure form that offerors must complete for solicitation HT003826RE001. The form requires an authorized representative of each company to declare whether the company, including all team entities (affiliates, subsidiaries, joint venture partners, subcontractors, consultants, and vendors), has an organizational conflict of interest relative to this procurement. Offerors must certify either that they have no OCI because they have not had access to non-public information regarding the solicitation and have not provided prior Government services that would position them to influence the competition, or they must disclose a potential OCI with a detailed attachment describing the conflict, relevant contract information, dates of activity, complete facts, and mitigation plans. Failure to provide the declaration, or misrepresenting or omitting information, may result in the offeror being deemed ineligible for award.
This document is a mandatory template and attachment to the broader Defense Health Agency solicitation HT003826RE001 for DHMS Deployment Solutions, a multiple award IDIQ contract for deployment services supporting DHMS products. The solicitation is open to all businesses (not set-aside for small business), with proposal submission required by April 15, 2026 at 12:00 PM Eastern Time and solicitation questions due by April 9, 2026. The OCI declaration and disclosure statement must be submitted with each proposal in compliance with FAR Part 9.5 requirements.
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Text version
HT003821R0001CUI//PROCURE
CUI//PROCURE
HT003826RE001
Program Executive Office (PEO) Defense Healthcare Management Systems (DHMS) Deployment Solutions
Attachment 16: Organizational Conflict of Interest Declaration and Disclosure
Solicitation Number: HT003826RE001 Program Executive Office, Defense Healthcare Management Systems (PEO DHMS)
BACKGROUND
It is the Government’s intent to vet all offerors to ensure they do not have Organizational Conflicts of Interest such that the Government must disqualify an offeror from competing for this procurement. Please refer to Revolutionary Federal Acquisition Regulation (FAR) Overhaul (RFO) 9.5. To that end, the Government requires that each offeror complete the following Organizational Conflict of Interest Declaration and Disclosure Statement.
OFFEROR’S OCI DECLARATION AND DISCLOSURE
Failure to provide the enclosed Organizational Conflict of Interest Declaration and Disclosure Statement, or omitting or misrepresenting information on the Statement, may result in the offeror being determined ineligible for award.
The undersigned, (Insert Name)_____, an authorized representative of ___(Insert Company Name)_____, (which is hereinafter referred to the “Company”), declares that my Company, including any entity[footnoteRef:1] on my team, to the best of my knowledge and belief, does not have an Organizational Conflict of Interest regarding solicitation HT003826RE001 as my Company has not: 1) had access to non-public information regarding solicitation HT003826RE001 that would assist my Company in obtaining the contract resulting from the solicitation[footnoteRef:2], and 2) has not provided services under any Government contract that put my company in a position to influence the competition under solicitation HT003826RE001[footnoteRef:3]. [1: An Entity shall include the offeror, its affiliates and subsidiaries, joint venture partners, subcontractors, consultants, and vendors.] [2: See RFO 9.505-4] [3: See RFO 9.505-1 and 9.505-2]
-OR-
The undersigned, (Insert Name)_____, an authorized representative of ___(Insert Company Name)_____, (which is hereinafter referred to the “Company”) declares that my Company, including any entity1 on my team, may have a potential Organizational Conflict of Interest regarding solicitation HT003826RE001, as my Company does have information that is likely relevant to the Government’s assessment of whether my Company has an Organizational Conflict of Interest. Therefore, I have provided a disclosure statement[footnoteRef:4] attached to this form which describes all relevant information bearing on this potential conflict under solicitation HT003826RE001. [4: The document will identify the company, Governmental agency, contract number, dates of activity, the complete facts relevant to the potential type of conflict, mitigation plans, or other pertinent information for the Government’s consideration and review.]
SIGNATURE
[Company’s Name] [Authorized Representative’s Typed Name] [Title] [Date]
CUI//PROCURE
CUI//PROCURE
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