Attachment 3 Organizational Conflict of Interest.pdf
PDF 3 MB Posted
- Attached to
- Lincoln, NE Emergency Homeless Shelter Services
- Solicitation number
- 36C26322Q0217
About this file
This solicitation requests proposals for emergency shelter and related services in Lincoln, Nebraska. The Department of Veterans Affairs, Veterans Health Administration, Network Contracting Office is seeking to award a contract starting April 1, 2022 to support the VA Nebraska-Western Iowa Health Care System's Health Care for Homeless Veterans program. Offerors must be able to provide all services outlined in the performance work statement in Lincoln. Proposals are due by 5 PM Central Standard Time on March 11, 2022 and shall be submitted via email to the contracting officer, Matthew Dale, at the provided email address. The solicitation number is 36C26322Q0217. Offerors must register in the System for Award Management and VIP database, if applicable, under NAICS code 624221 for temporary shelters with a $12M small business size standard. The solicitation will utilize full and open competition procedures. Questions regarding the solicitation are due by March 4 and shall reference the solicitation number in the subject line.
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Text version
SOLICITATION #:
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
] ____________________________________ represents that no individuals involved with the solicitation ________________________________ 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 Central Iowa Health Care System – Des Moines 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 Central Iowa Health Care System – Des Moines 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
Attachment 3 Organizational Conflicts of Interest Contractor Certification
CONTRACTOR NAME:
ADDRESS:
| Text3: |
| Contractor Company: |
| Solicitation#: |
| Address: |
| No COI affirmation: Choice1 |
| Date7_af_date: |
File details come from the government source that posted it. Updated .