K-3 Organizational Conflict of Interest Rev1

Organizational Conflict of Interest (OCI)
Certification & Assessment (DEAR 952.209-72 / Prime Contract I.74 (f)) (Required for awards anticipated to exceed the Simplified Acquisition Threshold, in support of advisory and assistance services, as defined in FAR 2.101.)

*For Offeror Use Only

I.

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FL-11

RFQ or RFP #:

REPRESENTATION/DISCLOSURE STATEMENT OF THE OFFEROR

The Offeror must complete either A or B of this section, but not both of the following Statements. A. OCI Representation Statement – Choose if No perceived OCI exists I hereby certify (or as a representative of my organization, I hereby certify) that, to the best of my knowledge and belief, no facts exist relevant to any past (within the past twelve months), present, or currently planned interest or activity (financial, contractual, personal, organizational or otherwise) which relate to the proposed work; and bear on whether I have (or the organization has) a possible conflict of interest with respect to (1) being able to render impartial, technically sound, and objective assistance or advice; or (2) being given an unfair1 competitive advantage. B. OCI Disclosure Statement – Choose if Identified Possible OCI & disclose relevant info I hereby certify (or as a representative of my organization, I hereby certify) that, to the best of my knowledge and belief, all relevant facts - - concerning past (within the past twelve months), present or currently planned interests or activities (financial, contractual, organizational or otherwise) which relate to the proposed work and bear on whether I have (or the organization has) a possible conflict of interest with respect to (1) being able to render impartial, technically sound, and objective assistance or advice, or page (s)
(2) being given an unfair1 competitive advantage - - are fully disclosed on the attached and formatted to show:
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For ease of presentation, divide following data into four parts: Organizational, contractual, financial, other;

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The company, agency, organization in which you have a past (within the past twelve months), present, or currently planned interest or activity (financial, contractual, organizational, or otherwise);

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A brief description of relationship;

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A period of relationship;

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The extent of relationship (e.g., value of financial interest of work; percent of total holdings, total work, etc.).

An unfair competitive advantage does not include the normal flow of benefits from the performance of the subcontract.