Attachment 4 Organizational Conflict of Interest.pdf

PDF 3 MB Posted

Attached to
Q523--36C26322Q0790 Neurophysiology NWI Start Date 09/01/2022
Solicitation number
36C26322Q0790
Issued by

About this file

Written by GovTribe AI ·

This solicitation is seeking proposals for neurophysiology and related services in the Omaha, Nebraska area for eligible Veteran beneficiaries. Offerors must be able to perform all requirements in the performance work statement starting on September 1, 2022. Proposals are due by 9:00 AM Central Standard Time on August 15, 2022. Interested offerors must download the solicitation from SAM.gov and submit their proposal to Shanna Comparato at Shanna.Comparato@va.gov. Offerors must be registered in SAM and VIP if applicable. The NAICS code is 621512 for diagnostic imaging centers with a small business size standard of $16.5M. The solicitation will be open to all responsible sources. Questions are due by August 8 and should reference solicitation number 36C26322Q0790. The contracting office is the Department of Veterans Affairs Network Contracting Office 23 located in St. Paul, Minnesota.

View the file

Other files

File Type Posted
Attachment 2 Contractor Rules of Behavior.pdf PDF
36C26322Q0790_1.docx DOCX document
36C26322Q0790 Final.pdf PDF
Attachment 8 NWI Blood Borne Pathogen Exposure Control Plan.pdf PDF
Attachment 1 QASP (Neurophysiology).pdf PDF
Attachment 3 Immigration and Nationality Act Certification.pdf PDF
Attachment 6 VA Patient Rights.pdf PDF
Attachment 7 NWI Blood and Body Fluid Exposure Management Procedure.pdf PDF
Attachment 10 Past Performance.pdf PDF
Attachment 5 Wage Determination 2015 5005 Rev 18.pdf PDF
Attachment 9 NWI Medical Staff Bylaws.pdf PDF
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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 Nebraska-Western Iowa VA 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 Nebraska- Western Iowa VA 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

Organizational Conflicts of Interest Contractor Certification

CONTRACTOR NAME:

ADDRESS:

Attachment 4: Organizational Conflict of Interest

Text3:
Contractor Company:
Solicitation#:
Address:
No COI affirmation: Choice1
Date7_af_date:

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