D.6 - Attachment 6 - Organizational Conflict of Interest.pdf
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- Solicitation number
- 36C26321R0093
About this file
This document includes a solicitation for diagnostic radiology technician services with cardiovascular experience. The solicitation requests proposals for one firm-fixed-price contract to provide diagnostic radiology technician services at the VA Minneapolis Health Care System located in Minneapolis, Minnesota. Proposals are due by April 9, 2021 at 10:59 AM EST and are to be emailed to the contracting officer. Offerors must complete the SF1449 form, provide contractor information, pricing in the price schedule, and a separate narrative addressing the technical and past performance evaluation criteria. The solicitation is set aside as total for SDVOSB and offerors must be registered in SAM and certified as an SDVOSB. The NAICS code is 561320 for diagnostic and medical laboratories with a size standard of $30 million. The contracting agency is the Department of Veterans Affairs Veterans Health Administration VISN 23.
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D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26321R0093, Diagnostic Radiological Technologist - Cardiovascular Services, Minneapolis VAHCS
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _____________________(Contractor Name) represents that the individuals listed in the Key Personnel section of the solicitation 36C26321R0093, Diagnostic Radiological Technologist - Cardiovascular 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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