ATTACHMENT 6 ORGANIZATIONAL CONFLICT OF INTEREST STATEMENT 8.20.2026.docx
DOCX document 23 KB Posted
- Solicitation number
- 36C26026Q0869
About this file
This is an Organizational Conflict of Interest (OCI) Statement certification form required for the Portland Teleradiology solicitation 36C26026Q0869. The form implements VAAR 852.209-70 and requires all offerors to disclose any past, present, or currently planned financial, contractual, organizational, or other interests that could create conflicts or provide unfair competitive advantages in performing work for the Veterans Affairs Portland Healthcare System (VAPORHCS). Offerors must certify either that key personnel and subcontractors have no conflicts of interest, or provide a detailed statement describing all relevant facts concerning potential conflicts and proposed mitigation strategies. Nondisclosure or misrepresentation of conflicts can result in contract termination at no expense to the Government, and unmitigated conflicts may warrant disqualification unless waived by the Contracting Officer under FAR 9.503.
The certification statement form is part of a Request for Quote (RFQ) for supplemental teleradiology services for the VA Portland Healthcare System. The procurement is set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) under NAICS code 621512 (Diagnostic Imaging Centers) with a $19.0 million small business size standard. Services required include multiple diagnostic imaging modalities—plain films, CT exams (including specialized protocols for cancer screening and angiography), ultrasound, MRI, nuclear medicine, and PET/CT—with estimated quantities ranging from 10 to 2,900 exams annually across 16 line items. Offerors must complete the conflict of interest certification with the certifying official's name, title, signature, and date before submitting their quote.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26026Q0869 0003.pdf | ||
| Price Cost excel worksheet.xlsx | XLSX spreadsheet | |
| Amendment_A0001_QA_36C26026Q0869.docx | DOCX document | |
| 36C26026Q0869 0003_1.docx | DOCX document | |
| ATTACHMENT 8 PRICE COST SCHEDULE 8.14.2026.docx | DOCX document | |
| 36C26026Q0869 0002.pdf | ||
| 36C26026Q0869 0002_1.docx | DOCX document | |
| 36C26026Q0869 0001.pdf | ||
| 36C26026Q0869 0001_1.docx | DOCX document | |
| ATTACHMENT 5 CONTRACTOR EMPLOYEE LEGAL STATUS.docx | DOCX document | |
| ATTACHMENT 6 ORGANIZATIONAL CONFLICT OF INTEREST STATEMENT.docx | DOCX document | |
| ATTACHMENT 7 CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document | |
| ATTACHMENT 3 KEY PERSONNEL LISTING.docx | DOCX document | |
| ATTACHMENT 1 PERFORMANCE WORK STATEMENT.docx | DOCX document | |
| ATTACHMENT 2 QASP.docx | DOCX document | |
| ATTACHMENT 8 PRICE COST SCHEDULE.docx | DOCX document | |
| ATTACHMENT 4 PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| 36C26026Q0869.docx | DOCX document |
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Text version
ATTACHMENT 6: 852.209-70. ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
All healthcare contracts require a response to the following provision as prescribed in VAAR 809.507-1(b). Please use the form in APPENDIX A to provide response.
ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
(a) It is in the best interest of the Government to avoid situations which might create an organizational conflict of interest or where the Offeror's performance of work under the contract may provide the Contractor with an unfair competitive advantage. The term 'organizational conflict of interest' means that because of other activities or relationships with other persons, a person is 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 the person has an unfair competitive advantage.
(b) The Offeror shall provide a statement with its offer which describes, 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.
(c) Based on this information and any other information solicited or obtained by the Contracting Officer, the Contracting Officer may determine that an organizational conflict of interest exists which would warrant disqualifying the Contractor for award of the contract unless the organizational conflict of interest can be mitigated to the Contracting Officer's satisfaction by negotiating terms and conditions of the contract to that effect. If the conflict of interest cannot be mitigated and if the Contracting Officer finds that it is in the best interest of the United States to award the contract, the Contracting Officer shall request a waiver in accordance with FAR 9.503.
(d) Nondisclosure or misrepresentation of actual or potential organizational conflicts of interest at the time of the offer or arising as a result of a modification to the contract, may result in the termination of the contract at no expense to the Government.
(End of provision)
APPENDIX A
[CONTRACTOR NAME]
[ADDRESS]
FIRST NOTICE # 36C26026Q0869
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 36C26026Q0869 Portland Teleradiology 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 Affairs Portland Healthcare System (VAPORHCS), 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 Affairs Portland Healthcare System (VAPORHCS) under the referenced first notice.
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 first notice. 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
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