Attachment 6 _ D.6 - Organizational Conflict of Interest.pdf

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Attached to
Q531--Nephrology Providers -VACIHCS New Stand Alone POP: 3/1/25-2/28/26+4
Solicitation number
36C26325R0005
Issued by

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This document is a Contractor Conflict of Interest Certification Statement submitted in response to Solicitation 36C26325R0005 for Nephrology Services at the Central Iowa VA Health Care System in Des Moines.

The document certifies that the contractor's key personnel have no present, planned, or past conflicts of interest relating to the services to be provided under the solicitation. Alternatively, the contractor may provide a statement describing any relevant facts concerning actual or potential organizational conflicts of interest. The certification must also cover any consultants and subcontractors identified in the contractor's proposal.

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Other files

File Type Posted
36C26325R0005 0004.pdf PDF
36C26325R0005_6.docx DOCX document
36C26325R0005 0003.pdf PDF
36C26325R0005_5.docx DOCX document
36C26325R0005 0002.pdf PDF
36C26325R0005_4.docx DOCX document
36C26325R0005_3.docx DOCX document
Attachment 4 D.4 - Immigration and Nationality Act Requirement.pdf PDF
Attachment 1 D.1 - VA Rules of Behavior.pdf PDF
Attachment 2 D.2 - Background Investigation Procedure and Documents.pdf PDF
Attachment 3 D.3 _ Quality Assurance Surveillance Plan -QASP.pdf PDF
Attachment 5 D.5 - VA Handbook 6500.6.pdf PDF
Attachment 6 D.6 - Organizational Conflict of Interest.pdf PDF
RFP-36C26325R0005-0001.pdf PDF
36C26325R0005 0001.pdf PDF
Attachment 5 _ D.5 - VA Handbook 6500.6.pdf PDF
Attachment 1 _ D.1 - VA Rules of Behavior.pdf PDF
36C26325R0005_2.docx DOCX document
RFP-36C26325R0005_1.pdf PDF
Attachment 3 _ D.3 _ Quality Assurance Surveillance Plan -QASP.pdf PDF
Attachment 2 _ D.2 - Background Investigation Procedure and Documents.pdf PDF
Attachment 4 _ D.4 - Immigration and Nationality Act Requirement.pdf PDF
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D.6 -Attachment 6 - Organizational Conflicts of Interest

CONTRACTOR NAME:

ADDRESS:

SOLICITATION 36C26325R0005, Nephrology Services, Des Moines CIVAHCS

CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT

[ ] (Contractor Name) represents that the individuals listed in the Key

Personnel section of the solicitation 36C26325R0005, Nephrology Services, 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 VA

Health Care System, Des Moines, 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 VA Health Care System, Des Moines, 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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