As prescribed in 9.507-1(c), insert the following provision:
ORGANIZATIONAL CONFLICTS OF INTEREST CERTIFICATE--ADVISORY AND ASSISTANCE SERVICES (NOV 1991)
(a) "Organizational conflict of interest" means that because of other activities or relationships with other persons, a person is unable or potentially unable to render impartial assistance or advice to the Government, or the person's objectivity in performing the contract work is or might be otherwise impaired, or a person has an unfair competitive advantage.
(b) An offeror notified that it is the apparent successful offeror shall provide the certificate described in paragraph (c) of this provision.
(c) The certificate must contain the following:
(1) Name of the agency and the number of the solicitation in question.
(2) The name, address, telephone number, and federal taxpayer identification number of the apparent successful offeror.
(3) A description of the nature of the services rendered by or to be rendered on the instant contract
(4) The name, address, telephone number of the client or client(s ), a description of the services rendered to the previous client(s), and the name of a officer or employee of the offeror who is knowledgeable about the services rendered to each client, if, in the 12* months preceding the date of the certification, services were rendered to the Government or any other (including a foreign government or person) respecting the same subject matter of the instant solicitation, or directly relating to such subject matter. The agency and contract number under which the services were rendered must also be included, if applicable.
*If approved by the head of the contracting activity, this period may be increased up to 36 months.
(5) A statement that the person who signs the certificate has mad inquiry and that, to the best of his or her knowledge and belief, no actual or potential conflict of interest or unfair competitive advantage exists with respect to the advisory and assistance services to be provided in connection with the instant contract, or that any actual or potential conflict of interest or unfair competitive advantage that does or may exist with respect to the contract in question has been communicated in writing to the Contracting Officer or his or her representatives.
(6) The signature, name, employer's name, address, and telephone number of the person who signed the certificate.
(d) Failure of the offeror to provide the certification may result in the offeror being determined ineligible for award. Misrepresentation of any fact may result in the assessment of penalties associated with false certifications or such other provisions provided by law or regulation.