Attachment 2 - Attestation Statement.docx
DOCX document 20 KB Posted
- Attached to
- National Dialysis Services Contract (NDSC) Federal contract opportunity
- Solicitation number
- 36C10G25R0022
About this file
The document is an Attestation Statement for the National Dialysis Services Contract (NDSC), Solicitation Number 36C10G25R0022, issued by the Department of Veterans Affairs Headquarters. The attestation certifies that all dialysis facilities proposed by the offeror are Medicare-certified and meet federal and state requirements for providing dialysis services.
The key certification requires the offeror to verify and maintain current Medicare certification for all proposed dialysis facilities throughout the contract term, with an obligation to promptly notify the agency of any changes in certification status. The document includes provisions for potential penalties, including contract termination, for providing false or misleading information, emphasizing the critical nature of Medicare compliance in this federal contract opportunity.
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Text version
Subject: Certification of Medicare Compliance for Dialysis Facilities Date: [Insert Date] To: [Insert Recipient Name/Agency Name] From: [Insert Offeror Name/Organization Name] I, [Insert Name], in my capacity as [Insert Title/Position] of [Insert Organization Name], hereby attest and certify that all dialysis facilities proposed by [Insert Organization Name] to be utilized in the resulting contract are Medicare-certified and meet all applicable federal and state requirements for providing dialysis services.
This certification is made in accordance with the requirements set forth in the solicitation [Insert Solicitation Number or Contract Reference, if applicable]. I further affirm that the Medicare certification status of all proposed dialysis facilities has been verified and is current as of the date of this attestation.
Should any changes occur in the Medicare certification status of the proposed dialysis facilities during the term of the contract, [Insert Organization Name] will promptly notify [Insert Recipient Name/Agency Name] and take appropriate actions to ensure compliance with contract requirements.
I understand that providing false, misleading, or inaccurate information in this attestation may result in penalties, including but not limited to termination of the contract and other legal or administrative actions.
Attested By:
[Signature] [Printed Name] [Title/Position] [Organization Name] [Contact Information]
File details come from the government source that posted it. Updated .