organizational conflicts of interest
pre-procurement fact sheet

REQUESTER:	PROCUREMENT SPECIALIST:	
M/S:                                  TEL:	M/S:                                 TEL:	
PURCHASE REQUEST NO.:	DATE:	

The work in your requested procurement activity appears to fall within one or more of the following categories.  Because subcontracts for work in these categories must be subjected to Organization Conflict of Interest (OCI) review and a DOE finding obtained before subcontract award,  a Pre-Procurement Fact Sheet needs to be completed to facilitate recognition of  an OCI.

Evaluation Services or Activities:  Any work or effort, having as its principal purpose, the independent study of a technology, process, product, or policy which entails the assessment, appraisal, or survey of such technology, process, product, or policy for purposes of comparison.

Technical Consulting and Management Support Services:  Any work or effort, having as its principal purpose, providing internal assistance to any program element or other organizational component of the Laboratory in the formulation or administration of its programs, projects, or policies, where it is necessary to give the subcontractor access to privileged information (Government/University/Laboratory information which is not to be disclosed outside the Laboratory)  and/or proprietary information (information which belongs to others but has been given to the University and may not be disclosed).  Such services typically include assistance in the preparing of program plans; evaluation, monitoring, or review of subcontractors' activities or proposals submitted by prospective subcontractors; and preparation of preliminary designs, specifications, or statements of work.

Professional Services:  Specialized services such as legal or medical services, but excluding architect/ engineering and other services defined elsewhere within this Fact sheet.

Other:  Contractual situations where there is a reasonable possibility that an OCI may exist or arise.

INSTRUCTIONS

Complete Sections a, b, and C of this Fact Sheet and return it to the Procurement Specialist listed above.  The Procurement Specialist will use it in gathering information from offerors concerning potential OCIs.  This information will be used by the Procurement Specialist and the DOE Contracting Officer in their OCI review.  It is expected that the Procurement Specialist will assist you in filling out the Fact Sheet.

Section A
PROCUREMENT DESCRIPTION

1.  Laboratory groups to be served by the subcontractor.	
	
a)	
b)	
c)	
d)	
2.  Brief description and purpose of the procurement and how the Laboratory will use the subcontractor's services        
     and work products:

	
3.  Brief description of work:

	
4.  If this is a follow-on effort to another subcontract, please give the subcontract no.:	

SECTION B
POTENTIAL ORGANIZATIONAL CONFLICT OF INTEREST
PROBLEM AREAS

Following are questions used to determine if the possibility of an OCI exists in this procurement.  A "yes" response does not automatically constitute an OCI.  Please use a supplemental sheet to explain "yes" answers.

1.  Does work involve preparation of specifications? 				  YES		  NO	
2.  Does the work involve preparation of a statement of work?			  YES		  NO	

3.  Does the work involve formulation of a detailed plan for specific 
     approaches or methodologies that are to be employed in or 
     incorporated into future procurement activity or involve access 
     to specifications, statements of work, or plans?				  YES		  NO

4.  On a supplemetal sheet, briefly state the relationship between
     1, 2, and 3 and any possible future procurement(s).  Indicate if other 
     Laboratory or government contractors or third parties may assist
     the subcontractor in the development of 1, 2, or 3.	

5.  a)  Will the subcontractor provide software?					  YES		  NO
     b)  If so, will the use of the software require the acquisition of new 
          automated data processing equipment?					  YES		  NO	

6.  a)  Will performance of the subcontract provide access to privileged
          information (such as unpublished information which has not been
          disclosed outside the Laboratory and internal information concerning
          Laboratory or government plans and programs)?				  YES		  NO
     b)  If yes, identify categories of information and the program elements
          involved.

7.  a)  Will performance of the subcontract provide access to proprietary 
          information (confidential information of others)?				  YES		  NO
     b)  If yes, identify categories of information.

8.  a)  Will the subcontractor's work products be used in connection with the
          formulation of Laboratory or government plans and strategies?		  YES		  NO
     b)  If yes, please describe the work products and the manner in which they
          will be used.

9.  a)  Will the subcontractor's performance include review, analysis, or 
          evaluation of services or products of Laboratory subcontractors or
          government contractors?						  YES		  NO
     b)  If yes, briefly identify such services and products.

	

SECTION C
SIGNATURE

I hereby certify that the information I have provided above is true and accurate to the best of my knowledge.

_________________________________________                             _________________
Laboratory Requester's Signature						Date