Attachment 2 - Organizational Conflict of Interest.pdf

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Attached to
G099--Homeless Veterans Outreach Center Base Year (11/1/23 to 10/31/24) + 4 OYs Rapid City, SD
Solicitation number
36C26323Q0773
Issued by

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This document contains an organizational conflict of interest certification statement for solicitation number 36C26323Q0773 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23. The statement requires the contractor to disclose whether any individuals involved with the solicitation have any present, planned, or past financial, contractual, organizational, or other conflicts of interest relating to the homeless veterans outreach center services being solicited in Rapid City, South Dakota. The contractor must either certify that no such conflicts exist or provide an attached statement describing any relevant facts concerning potential organizational conflicts of interest and how the contractor's system would avoid or mitigate them.

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Other files

File Type Posted
36C26323Q0773 0001.pdf PDF
36C26323Q0773_1.docx DOCX document
Attachment 3 - Quality Assurance Surveillance Plan.pdf PDF
Attachment 1 - Immigration and Nationality Act Requirement.pdf PDF
Attachment 4 - Rules of Behavior (VHA Handbook 6500.6 Appendix D).pdf PDF
36C26323Q0773.pdf PDF
Attachment 5 - Wage Determination.pdf PDF

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CONTRACTOR NAME:

ADDRESS:

SOLICITATION #

CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT

[ ] ____________________________________ represents that no individuals involved with the

CONTRACTOR NAME

solicitation [_______________________________] in have no present, or currently planned interest SOLICITATION # and SERVICE TYPE

(financial, contractual, organizational, or otherwise) or actual or organizational conflicts of interest relating to the services to be provided to the VA Iowa City Health Care System 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 VA Iowa City Health Care System 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

Attachment 2: Conflict of Interest Statement

File details come from the government source that posted it. Updated .