Attachment 4-Organizational Conflict of Interest.pdf
PDF 114 KB Posted
- Attached to
- UPDATED Neuromonitoring Services - SLC VAMC Federal contract opportunity
- Solicitation number
- 36C25926Q0822
About this file
This is a template for a Contractor Conflict of Interest Certification Statement required for Veterans Administration Medical Center (VAMC) solicitations.
The document requires contractors to certify their conflict of interest status regarding a specific solicitation. Contractors must select one of two options: either certify that no individuals involved in the solicitation have any present, past, or currently planned financial, contractual, organizational, or other conflicts of interest relating to the services to be provided to the named VAMC; or attach a detailed statement describing all relevant facts concerning any past, present, or currently planned conflicts of interest. If conflicts exist, the offeror must provide the same conflict of interest information for all identified consultants and subcontractors that will provide services under the solicitation. The offeror may additionally provide facts demonstrating how its organizational and management systems would avoid or mitigate any actual or potential organizational conflicts of interest. The certification must be signed by an authorized certifying official with their printed name, title, signature, and date.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 5-Wage Determination No 15-5489.pdf | ||
| 36C25926Q0822 0001.pdf | ||
| Attachment 3-Contractor immigration certification.pdf | ||
| S02 36C25926Q0822.pdf | ||
| Attachment 1-Quality Assurance Surveillance Plan QASP.pdf | ||
| Attachment 2-Contractors Rules of Behavior.pdf |
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Text version
Organizational Conflict of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION #
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that no individuals involved with the solicitation [____Solicitation # and Service Type___] 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 ___[NAME OF 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___NAME OF 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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