Attachment 6 D.6 - Organizational Conflict of Interest.pdf
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- Solicitation number
- 36C26325R0005
About this file
This document is an Organizational Conflict of Interest (OCI) Certification Statement from the contractor for Solicitation 36C26325R0005 for Nephrology Services at the Central Iowa VA Health Care System in Des Moines. The contractor certifies that the individuals proposed as key personnel have no present or planned financial, contractual, organizational, or other conflicts of interest relating to the services to be provided under this solicitation. The contractor acknowledges that it must also provide the same information for any consultants and subcontractors identified in its proposal. The solicitation is for the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 23 to provide nephrology services for a 1-year base period with four 1-year option periods.
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D.6 -Attachment 6 - Organizational Conflicts of Interest
CONTRACTOR NAME:
ADDRESS:
SOLICITATION 36C26325R0005, Nephrology Services, Des Moines CIVAHCS
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] (Contractor Name) represents that the individuals listed in the Key
Personnel section of the solicitation 36C26325R0005, Nephrology 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 Central Iowa VA
Health Care System, Des Moines, 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 Central Iowa VA Health Care System, Des Moines, 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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