Attachment 3 - Organizational Conflict of Interest.docx
DOCX document 23 KB Posted
- Attached to
- Nephrology Services
- Solicitation number
- 36C26124Q0255
About this file
This document is a Contractor Conflict of Interest Certification Statement related to Solicitation #36C26124Q0229 for Nephrology Physicians and Physician Extenders services to be provided to the VA Sierra Nevada Health Care System Veterans Administration. The contractor certifies that no individuals involved in this solicitation have any present, planned, or past financial, contractual, organizational, or other interests or conflicts of interest related to the required services. The contractor must attach a statement describing any relevant facts about past, present, or planned interests or conflicts of interest if they exist. This certification is required to be submitted with the contractor's offer for this solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26124Q0255 0001.pdf | ||
| 36C26124Q0255 - Nephrology.pdf | ||
| Attachment 2 - IMMIGRAT_CERT.docx | DOCX document | |
| Attachment 1 - QASP.pdf | ||
| 36C26124Q0255 - Nephrology.pdf | ||
| Attachment 4 - Past Performance Questionnaire.docx | DOCX document |
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Text version
Organizational Conflict of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26124Q0229
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that no individuals involved with the solicitation 36C26124Q0229 – Nephrology Physicians and Physician Extenders 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 VA Sierra Nevada Health Care System 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 VA Sierra Nevada Health Care System 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
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