D.6 Organizational Conflict of Interest.pdf
PDF 128 KB Posted
- Attached to
- Q502--Perfusion Services Federal contract opportunity
- Solicitation number
- 36C26320R0148
About this file
This document contains a federal contract opportunity notice for perfusion services at the Minneapolis VA Health Care System. The solicitation seeks proposals for a one-year base period of perfusion services beginning August 1, 2020 through July 31, 2021, with four optional one-year renewal periods. Services include on-site clinical perfusionist coverage Monday through Friday for an estimated 3,276 hours annually, as well as on-call coverage for an estimated 1,632 hours annually. The scope of work involves direct patient care management for cardiovascular surgical patients, extracorporeal life support functions, and other clinical perfusion procedures as required. Interested parties should direct any questions in writing to the point of contact provided by the specified deadline.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26320R0148 0002.pdf | ||
| 36C26320R0148_4.docx | DOCX document | |
| A0001.pdf | ||
| 36C26320R0148_3.docx | DOCX document | |
| D.3 Quality Assurance Surveillance Plan (QASP).pdf | ||
| D.1 VA Rules of Behavior.pdf | ||
| D.7 Past Performance Questionnaire-Perfusion Services.pdf | ||
| D.4 Immigration and Nationality Act Requirement.pdf | ||
| S02 - 36C26320R0148.pdf | ||
| D.5 VA Handbook 6500.6.pdf | ||
| D.2 Background Investigation Procedure and Documents.pdf | ||
| 36C26320R0148_1.docx | DOCX document |
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Text version
D.6 – Attachment 6
Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26320R0148, Perfusion Services Minneapolis VAHCS
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that the individuals listed in the Key Personnel section of the solicitation 36C26320R0148, Perfusion Services, 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 Minneapolis VA 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 Minneapolis VA 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 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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