D.5 Organizational Conflict of Interest.pdf
PDF 181 KB Posted
- Attached to
- Q301--New Reference Lab Testing | Legacy VISN 15
- Solicitation number
- 36C25526R0066_1
About this file
This document is a Contractor Conflict of Interest Certification Statement form for solicitation 36C25526R066 issued by the Veterans Administration for Referral Lab Services to be provided to Veterans Integrated Services Network (VISN) 15.
The form requires contractors to certify either that no individuals involved with the solicitation have any 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, or alternatively, to attach a detailed statement describing all relevant facts concerning any such conflicts. If conflicts exist, the contractor must disclose the same information for any identified consultants and subcontractors that will provide services under the solicitation, and may provide facts demonstrating how organizational or management systems would avoid or mitigate conflicts. The certification must be signed by an authorized official with title and date provided.
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Other files
| File | Type | Posted |
|---|---|---|
| D.3 Quality Assurance Surveillance Plan QASP.pdf | ||
| D.9 Subcontracting Plan Template.docx | DOCX document | |
| 36C25526R0066_1.docx | DOCX document | |
| D.4 Contractor Rules of Behavior.pdf | ||
| D.10 Applicable Wage Determinations.pdf | ||
| D.7 Key Personnel Roster.pdf | ||
| D.2 Test Schedule Instructions.docx | DOCX document | |
| D.6 Immigration and Nationality Act.pdf | ||
| D.8 Past Performance Questionnaire.pdf | ||
| D.1 Test Schedule.xlsx | XLSX spreadsheet |
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Text version
D.5 Organizational Conflict of Interest 36C25526R066
CONTRACTOR NAME:
ADDRESS:
SOLICITATION # 36C25526R066
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____ ________________ represents that no individuals involved with the solicitation 36C25526R066 for Referral Lab Services in have no present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or organizational conflicts of interest relating to the services to be provided to the Veterans Integrated Services Network (VISN) 15 Veterans Administration under the referenced solicitation.
None of the employees listed in the solicitation have a past interest (financial, contractual, organizational, or otherwise) or actual or organizational conflicts of interest relating to the services to be provided to the Veterans Integrated Services Network (VISN) 15 Veterans Administration under the referenced solicitation.
OR
[ ] Statement attached describing, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided under this solicitation. The offeror shall also provide statements with its offer containing the same information for any consultants and subcontractors identified in its proposal and which will provide services under the solicitation. The offeror may also provide relevant facts that show how its organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.
NAME OF CERTIFYING OFFICIAL/TITLE
SIGNATURE DATE
| CONTRACTOR NAME: |
| ADDRESS: |
| NAME OF CERTIFYING OFFICIALTITLE: |
| Contractor Name 2: |
| Check Box1: Off |
| Check Box2: Off |
| Date: |
File details come from the government source that posted it. Updated .