S02 D.7 Organizational Conflicts of Interest - 05-28-2026.docx
DOCX document 25 KB Posted
- Solicitation number
- 36C25726Q0159
About this file
This is an Organizational Conflicts of Interest (OCI) Certification Statement template for federal contract solicitation 36C25726Q0159, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17 (VISN 17). The document is a required certification appendix that contractors must complete when submitting quotes for Locum Gastroenterology (GI) Physician Services to the South Texas Veterans Health Care System.
The certification requires the contractor to declare whether key personnel and temporary emergency substitutions identified in the solicitation have any present, past, or currently planned financial, contractual, organizational, or other interests that could create actual or potential organizational conflicts of interest related to service delivery. Contractors must select one of two options: certify that no conflicts of interest exist among listed employees, or attach a detailed statement describing all relevant facts concerning any past, present, or planned conflicts of interest. If conflicts are identified, contractors may also provide statements explaining how their organizational and management systems would avoid or mitigate such conflicts. The certification must be signed by an authorized official and submitted with the quote, along with corresponding statements for any identified consultants and subcontractors who will provide services under the solicitation.
View the file
Other files
Show all 19
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
D.20 Organizational Conflicts of Interest – RFQ 36C25726Q0159
APPENDIX A
Contractor Name Address
SOLICITATION 36C25726Q0159
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] Contractor Name represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of the solicitation [36C25726Q0159 – Locum Gastroenterology (GI) Physician 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 South Texas Veterans Health Care System 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 South Texas Veterans Health Care System 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 quoter shall also provide statements with its quote containing the same information for any consultants and subcontractors identified in its solicitation and which will provide services under the solicitation. The quoter 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
File details come from the government source that posted it. Updated .