D.3 - Organizational Conflict of Interest.docx

This is an Organizational Conflict of Interest (OCI) Certification Statement form for solicitation 36C24926R0040, a locum perfusionist services contract with the Department of Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) VAMC in Nashville, Tennessee. The form certifies that individuals involved with the solicitation have no present, planned, or past financial, contractual, organizational, or other interests that would create actual or potential organizational conflicts of interest relating to the services to be provided. The contractor must certify compliance with this requirement and provide the same certification for any consultants or subcontractors identified in the proposal. The form includes provisions for contractors to attach statements describing relevant facts concerning any actual or potential conflicts of interest and may include information on how organizational or management systems would mitigate such conflicts.

The underlying solicitation is a sources sought notice for locum perfusionist services with a performance period of June 1, 2026 through May 31, 2027, with a base contract plus four option periods (ultimate completion date May 31, 2031). The service will be provided on-site at TVHS VAMC in Nashville, Tennessee, on a 24/7 basis including holidays in support of cardiovascular services, with one contractor perfusionist on-site Monday through Friday (excluding federal holidays) and one on-call coverage. The Product Service Code is Q502, NAICS code 621999, and responses are due by May 4, 2026 at 5:00 p.m. EST. The contracting office is Department of Veterans Affairs Network Contracting Office 9, with Contract Officer Samantha Shackelford as the point of contact (Samantha.shackelford@va.gov).