ATTACHMENT 2 - CONTRACTOR KEY PERSONNEL AND COI.pdf

RFQ 36C25623Q0529_1

CONTRACTOR KEY PERSONNEL & COI

ATTACHMENT 2

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 Veterans Health Care System of the Ozarks 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 Veterans Health Care System of the Ozarks under the solicitation/contract here in.

Please identify also, if they are an employee of the prime or subcontractor.

NAME TITLE PRIME OR SUBCONTRACTOR

Provide the number of hours worked weekly by each of the physicians. Do not limit the response to the number of hours expended or expected to be spent at VA; provide the total number of hours worked weekly by the physicians, including time spent in research, clinical, administrative, and other duties for the Practice group.

Provide the expected percentage of total effort for each proposed physician that will be provided fulfilling the duties and responsibilities specified in the Performance Work Statement. Additionally, provide the percentage of total effort that each proposed physician will be expected to spend fulfilling non-VA obligations. This can be expressed as a percentage of the physician’s total annual effort.

PHYSICIAN

NAME

AVERAGE

WEEKLY

HOURS

PERCENT OF

EFFORT –VA

PERCENT OF

EFFORT –

PRACTICE

GROUP

NOTE: This attachment shall be updated after contract award once the Offeror has had an attempt to recruit existing physicians.