Attachment 4 Organizational Conflict of Interest.pdf

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Q403--NWI MRI Solicitation Amendment 0001 POP 01OCT22-30SEP27
Solicitation number
36C26322Q0878
Issued by

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This solicitation requests proposals for magnetic imaging resonance and related services. The Department of Veterans Affairs, Veterans Health Administration, Network Contracting Office is seeking to award a contract to provide MRI services in Lincoln and Grand Island, Nebraska for eligible Veteran beneficiaries within the VA Nebraska-Western Iowa Health Care System. Offerors must be able to perform all requirements of the performance work statement starting on October 1st, 2022, including providing both the MRI services and necessary equipment. This is a set-aside for certified Service-Disabled Veteran-Owned or Veteran-Owned small businesses. Proposals are due by September 6th, 2022 and the successful offeror must directly perform at least 50% of the requirement. The NAICS code is 621512 and the small business size standard is $16.5 million.

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Other files

File Type Posted
36C26322Q0878 0001.pdf PDF
36C26322Q0878 0001_1.docx DOCX document
Attachment 5 Business Associate Agreement.pdf PDF
Attachment 6 Past Performance.pdf PDF
Attachment 2 Contractor Rules of Behavior.pdf PDF
36C26322Q0878.pdf PDF
Attachment 3 Immigration and Nationality Act Certification.pdf PDF
36C26322Q0878.docx DOCX document
Attachment 1 Quality Assurance Surveillance Plan (QASP).pdf PDF

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Attachment 4: Organizational Conflict of Interest

[ ] Contractor represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of the solicitation 36C26322Q0878 for MRI Services in for the VA Nebraska-Western Iowa Health Care System (NWIVAHCS) 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 NWIVAHCS 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 NWIVAHCS 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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