Attachment 2 - Contractor Organizational Conflict of Interest.pdf
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- Attached to
- MSO-2020-CMP-0025 Bowling Green CBOC Federal contract opportunity
- Solicitation number
- 36C24920R0048
About this file
This document contains a template certification statement regarding organizational conflicts of interest for contractors responding to solicitation number 36C24920R0048 for the Bowling Green CBOC project through the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9. The template requires the contractor to certify that its key personnel listed in the solicitation have no present, past, or planned financial, contractual, organizational or other conflicts relating to services provided under the solicitation. It also requires the contractor to provide statements describing any relevant conflicts for any identified consultants or subcontractors. The contractor may also provide facts demonstrating how its system or actions would avoid or mitigate potential organizational conflicts.
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Text version
Attachment 2 – Contractor Organizational Conflict of Interest
APPENDIX A
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION #
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of the solicitation [____Solicitation # and Service Type___] 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 ___[NAME OF VAMC] _________ Veterans Administration 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___NAME OF VAMC _________ Veterans Administration 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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