ATT D4 KEY PERSONNEL.docx
DOCX document 16 KB Posted
- Solicitation number
- 36C25625R0028
About this file
This is a key personnel and conflict of interest (COI) form template labeled as Attachment D4 for the Kosciusko CBOC Services solicitation at the G.V. Sonny Montgomery VA Medical Center. The document requires contractors to list key personnel and temporary emergency substitutions, confirming that these individuals have no present, planned, or past interests (financial, contractual, organizational) that would constitute conflicts of interest related to the services being provided. The form requires listing each individual's name, position/title, and whether they are employed by the prime contractor or subcontractor.
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ATTACHMENT D4- Key Personnel and COI Contractor____________________ represents that the individuals listed below for Key Personnel and Temporary Emergency Substitutions of this solicitation here 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 G.V. Sonny Montgomery VA Medical Center under the solicitation/contract here in.
None of the employees listed below in this 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 G.V. Sonny Montgomery VA Medical Center under the solicitation/contract here in.
Please identify also if they are an employee of the prime or subcontractor.
| NAME (physician and other clinical and nonclinical staff) |
| Position/TITLE |
| PRIME OR SUBCONTRACTOR |
File details come from the government source that posted it. Updated .