ATTACHMENT 3 - CONFLICT OF INTEREST CERTIFICATION STATEMENT.pdf
PDF 288 KB Posted
- Attached to
- Q522-- Mobile CT Lung Cancer Screening Federal contract opportunity
- Solicitation number
- 36C24924R0075_0003
About this file
This is an Organizational Conflicts of Interest (OCI) certification statement attachment for RFQ No. 36C24924R0075, which is required for healthcare contracts as prescribed in VAAR 809.507-1(b). The document is associated with a Mobile CT Lung Cancer Screening Services contract for James H. Quillen and Lexington VAMC CBOCs under the Department of Veterans Affairs.
The attachment includes a certification form (Appendix A) that requires contractors to either certify they have no conflicts of interest or provide a detailed statement describing any past, present, or planned interests that could create potential conflicts. Contractors must disclose any financial, contractual, or organizational relationships that could affect their ability to provide impartial services to the Memphis VA Medical Center. The form requires contractors to include this information for all key personnel, temporary emergency substitutions, consultants, and subcontractors. The document warns that nondisclosure or misrepresentation of conflicts could result in contract termination at no expense to the government.
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Text version
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 of provision)
RFQ NO. 36C24924R0075
ATTACHMENT 3 - CONFLICT OF INTEREST CERTIFICATION STATEMENT
APPENDIX A
CONTRACTOR COMPANY NAME AND UEI
SOLICITATION # 36C24924R0075
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _________________________ represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of solicitation number 36C24924R0075 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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