OCI Disclosure Form

OCI Disclosure Form
Attachment 7

INSTRUCTIONS FOR COMPLETING

NOTE: One Attachment to the OCI Disclosure Form shall be submitted for each USSOCOM contract or subcontract currently being performed. Place an "X" inside the appropriate parenthesis to indicate your responses.

Fill in the number and the short, official title by which the contract or subcontract requiring analysis and determination is formally known. This is work that has already been awarded, is being performed by your company, and requires a comparison with that work identified in the Statement of Work.

INSTRUCTIONS FOR COMPLETING

NOTE: One Attachment to the OCI Disclosure Form shall be submitted for each USSOCOM contract or subcontract currently being performed. Place an "X" inside the appropriate parenthesis to indicate your responses.

Fill in the number and the short, official title by which the contract or subcontract requiring analysis and determination is formally known. This is work that has already been awarded, is being performed by your company, and requires a comparison with that work identified in the Statement of Work.

1. Please identify below the contract or subcontract held by your firm or affiliate and which may create an actual or potential OCI:

Contractor, Subcontractor or Affiliate’s Name:
Contract or Program Title:
Contracting Agency or Customer:
Contract Number:
Task Order Number (if applicable):

2. Your performance in the above contract is as a: Prime (__) or Subcontractor (__)

3. If Subcontractor, what is magnitude of work compared to overall contract value?

5. Describe below the scope of the contract or subcontract in sufficient detail to understand the breadth of the work, the period of performance and the value, as it relates to: () Providing Systems Engineering and Technical Direction (FAR 9.505-1) () Preparing Specifications or Work Statements (FAR 9.505-2) () Providing Technical Evaluation of Offers for Products or Services (FAR 9.505-3) () Obtaining Access to Proprietary Information (FAR 9.505-4) () Providing products, hardware or software to USSOCOM

6. Scope (continue on additional pages if more space is necessary):

7. Does the scope of work for this contract or subcontract create an actual or potential conflict of interest with the work you wish to perform with MARSOC or SOCOM contracts? If so, describe the actual or potential conflict.