Attachment 3 - Organizational Conflict of Interest 36C24925Q0011.docx
DOCX document 26 KB Posted
- Solicitation number
- 36C24925Q0011
About this file
This document is an Organizational Conflict of Interest (OCI) certification statement for Solicitation #36C24925Q0011 - Hematology Oncology Services for the Robley Rex VA Medical Center. The contractor must certify whether any individuals or their affiliates involved in this solicitation have any present, planned, or past financial, contractual, organizational, or other interests that could result in an actual or potential conflict of interest in providing the required hematology oncology services. If a potential conflict exists, the contractor must disclose relevant facts about the conflict and how they will mitigate it. This OCI statement is a required attachment for the solicitation, which is seeking personnel to provide onsite hematology oncology services at the Robley Rex VA Medical Center for the period of 1/1/25 - 12/31/25.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24925Q0011 Amendment 0001.docx | DOCX document | |
| Attachment 2 QASP - Hematology Oncology 36C24925Q0011.docx | DOCX document | |
| Attachment 4 - Contractor Certification Immigration and Nationality Act of 1952 36C24925Q0011.docx | DOCX document | |
| 36C24925Q0011.docx | DOCX document | |
| Attachment 1 PWS - Hem Onc - Onsite Physician Services 36C24925Q0011.docx | DOCX document |
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Text version
36C24925Q0011
LOU HEMATOLOGY ONCOLOGY SERVICES
ATTACHMENT 3 – CONFLICT OF INTEREST
Organizational Conflict of Interest
CONTRACTOR NAME: ____________________________________________
ADDRESS: _______________________________________________________ _________________________________________________________________ _________________________________________________________________
SOLICITATION # 36C24925Q0011
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ______________ represents that no individuals involved with the solicitation __36C24925Q0011 Hematology Oncology Services___ 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 __Robley Rex 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___ Robley Rex 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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