36C25918R0573-003.docx
DOCX document 18 KB Posted
- Solicitation number
- 36C25918R0573
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This document contains an attachment for a solicitation for inpatient dialysis services. The Gulf Coast Veterans Health Care System is seeking proposals for inpatient dialysis from physicians, and the attachment requires disclosure of conflicts of interest and non-VA obligations for proposed key personnel. For each proposed physician, offerors must provide their name, average weekly hours, percentage of total effort to be provided fulfilling duties under the VA contract, percentage of total effort spent on non-VA obligations, and the hourly rate to be paid. This attachment will be updated after contract award to include recruitment efforts for existing physicians.
36C25918R0573 ATTACHMENT B - CONTRACTOR KEY PERSONNEL AND COI.docx
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25918D0257-000.docx | DOCX document | |
| 36C25918R0573-0002000.docx | DOCX document | |
| 36C25918R0573-0001000.docx | DOCX document | |
| 36C25918R0573-002.docx | DOCX document | |
| 36C25918R0573-005.docx | DOCX document | |
| 36C25918R0573-007.docx | DOCX document | |
| 36C25918R0573-001.docx | DOCX document | |
| 36C25918R0573-008.docx | DOCX document | |
| 36C25918R0573-004.docx | DOCX document | |
| 36C25918R0573-006.docx | DOCX document | |
| 36C25918R0573-000.docx | DOCX document |
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ATTACHMENT B
Contractor____________________ represents that the individuals listed below for Key Personnel and Temporary Emergency Substitutions of this solicitation here 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 Gulf Coast Veterans Health Care System under the solicitation/contract here in.
None of the employees listed below in this 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 Gulf Coast Veterans Health Care System under the solicitation/contract here in.
Please identify also, if they are an employee of the prime or subcontractor.
| NAME |
| TITLE |
| PRIME OR SUBCONTRACTOR |
Provide the number of hours worked weekly by each of the physicians. Do not limit the response to the number of hours expended or expected to be spent at VA; provide the total number of hours worked weekly by the physicians, including time spent in research, clinical, administrative, and other duties for the Practice group.
Provide the expected percentage of total effort for each proposed physician that will be provided fulfilling the duties and responsibilities specified in the Performance Work Statement. Additionally, provide the percentage of total effort that each proposed physician will be expected to spend fulfilling non-VA obligations. This can be expressed as a percentage of the physician’s total annual effort.
Lastly, provide the hourly rate that each proposed physician would be paid providing these services.
| PHYSICIAN NAME |
| AVERAGE WEEKLY HOURS |
| PERCENT OF EFFORT –VA |
| PERCENT OF EFFORT – PRACTICE GROUP |
| HOURLY RATE THAT PHYSICIAN WILL BE PAID |
NOTE: This attachment shall be updated after contract award once the Offeror has had an attempt to recruit existing physicians.
File details come from the government source that posted it. Updated .