ATTACHMENT 3 - CONFLICT OF INTEREST CERTIFICATION STATEMENT.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C24926Q0380
About this file
This is a Conflict of Interest Certification Statement form required for submission with proposals in response to solicitation 36C24926Q0380 for Medical Physicist Services at the James H. Quillen VA Medical Center in Mt. Home, Tennessee. The form implements VAAR provision 852.209-70 (Organizational Conflicts of Interest) and requires all offerors to certify the conflict of interest status of key personnel, temporary emergency substitutions, consultants, and subcontractors identified in their proposals.
Offerors must select one of two certification options: either certify that no individuals listed have any present, past, or currently planned financial, contractual, organizational, or other interests that would create actual or potential organizational conflicts of interest; or submit a detailed statement describing all relevant facts concerning any such conflicts, along with proposed mitigation measures or management systems to address identified conflicts. The Contracting Officer retains the authority to determine whether conflicts warrant disqualification, request mitigation through contract terms, or pursue a waiver in accordance with FAR 9.503. Nondisclosure or misrepresentation of conflicts may result in contract termination at no expense to the Government. The form requires completion by the contractor company with UEI, solicitation number, certifying official name and title, signature, and date.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24926Q0380 0002.docx | DOCX document | |
| 36C24926Q0380 0001.docx | DOCX document | |
| ATTACHMENT 1 - QUALITY ASSURANCE SURVEILLANCE PLAN.docx | DOCX document | |
| ATTACHMENT 2 - CONTRACTOR CERTIFICATION IMMIGRATION AND NATIONALITY ACT OF 1952 AS AMENDED.docx | DOCX document | |
| 36C24926Q0380.docx | DOCX document |
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ATTACHMENT 3 - CONFLICT OF INTEREST CERTIFICATION STATEMENT
852.209-70. ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
All healthcare contracts require response to the following provision as prescribed in VAAR 809.507-1(b). Please use the form in APPENDIX A to provide response.
ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
(a) It is in the best interest of the Government to avoid situations which might create an organizational conflict of interest or where the Offeror's performance of work under the contract may provide the Contractor with an unfair competitive advantage. The term 'organizational conflict of interest' means that because of other activities or relationships with other persons, a person is unable to render impartial assistance or advice to the Government, or the person's objectivity in performing the contract work is or might be otherwise impaired, or the person has an unfair competitive advantage.
(b) The Offeror shall provide a statement with its offer which describes, 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.
(c) Based on this information and any other information solicited or obtained by the Contracting Officer, the Contracting Officer may determine that an organizational conflict of interest exists which would warrant disqualifying the Contractor for award of the contract unless the organizational conflict of interest can be mitigated to the Contracting Officer's satisfaction by negotiating terms and conditions of the contract to that effect. If the conflict of interest cannot be mitigated and if the Contracting Officer finds that it is in the best interest of the United States to award the contract, the Contracting Officer shall request a waiver in accordance with FAR 9.503.
(d) Nondisclosure or misrepresentation of actual or potential organizational conflicts of interest at the time of the offer or arising as a result of a modification to the contract, may result in the termination of the contract at no expense to the Government.
(End) 36C24926Q0380 Medical Physicist
APPENDIX A
CONTRACTOR COMPANY NAME AND UEI
SOLICITATION # 36C24926Q0334
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of solicitation number 36C24926Q0334 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 Memphis VA Medical Center 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 Memphis VA Medical Center 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 AND TITLE OF CERTIFYING OFFICIAL
SIGNATURE DATE
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