ATTACHMENT 6 ORGANIZATIONAL CONFLICT OF INTEREST STATEMENT.docx
DOCX document 23 KB Posted
- Solicitation number
- 36C26026Q0204
About this file
This is an Organizational Conflicts of Interest (OCI) statement form required for response to solicitation 36C26026Q0204 for Acute Bedside Dialysis Services at the Department of Veterans Affairs Medical Center in Boise, Idaho. The form implements VAAR 852.209-70 (October 2020) and requires all contractors to disclose any past, present, or currently planned financial, contractual, organizational, or other interests that could create conflicts or impair objectivity in performing the contracted services. Contractors must certify either that key personnel and identified subcontractors have no conflicts of interest, or provide a detailed statement describing all relevant facts concerning actual or potential conflicts and explain any mitigation measures through organizational or management systems.
The certification must be completed by a designated official and submitted with the offer. Nondisclosure or misrepresentation of conflicts of interest can result in contract termination at no expense to the Government. The Contracting Officer may disqualify an offeror based on identified conflicts unless they can be mitigated through contract terms, or may request a waiver if proceeding is deemed in the Government's best interest. This form is a template appendix and does not address specific products or services but rather establishes the compliance framework for conflict of interest declarations in the solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 3 KEY PERSONNEL LISTING.docx | DOCX document | |
| ATTACHMENT 5 CONTRACTOR EMPLOYEE LEGAL STATUS.docx | DOCX document | |
| ATTACHMENT 1 PERFORMANCE WORK STATEMENT.docx | DOCX document | |
| 36C26026Q0204.docx | DOCX document | |
| ATTACHMENT 7 CONTRACTOR RULES OF BEHAVIOR.docx | DOCX document | |
| ATTACHMENT 8 PRICE COST SCHEDULE.docx | DOCX document | |
| ATTACHMENT 4 PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| ATTACHMENT 2 QASP .docx | DOCX document |
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ATTACHMENT 6: 852.209-70. ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
All healthcare contracts require a response to the following provision as prescribed in VAAR 809.507-1(b). Please use the form in APPENDIX A to provide response.
ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
(a) It is in the best interest of the Government to avoid situations which might create an organizational conflict of interest or where the Offeror's performance of work under the contract may provide the Contractor with an unfair competitive advantage. The term 'organizational conflict of interest' means that because of other activities or relationships with other persons, a person is unable to render impartial assistance or advice to the Government, or the person's objectivity in performing the contract work is or might be otherwise impaired, or the person has an unfair competitive advantage.
(b) The Offeror shall provide a statement with its offer which describes, 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.
(c) Based on this information and any other information solicited or obtained by the Contracting Officer, the Contracting Officer may determine that an organizational conflict of interest exists which would warrant disqualifying the Contractor for award of the contract unless the organizational conflict of interest can be mitigated to the Contracting Officer's satisfaction by negotiating terms and conditions of the contract to that effect. If the conflict of interest cannot be mitigated and if the Contracting Officer finds that it is in the best interest of the United States to award the contract, the Contracting Officer shall request a waiver in accordance with FAR 9.503.
(d) Nondisclosure or misrepresentation of actual or potential organizational conflicts of interest at the time of the offer or arising as a result of a modification to the contract, may result in the termination of the contract at no expense to the Government.
(End of provision)
APPENDIX A
[CONTRACTOR NAME]
[ADDRESS]
FIRST NOTICE # 36C26026Q0204
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of the solicitation 36C26026Q0204 Acute Bedside Dialysis 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 Veterans Affairs Portland Healthcare System (VAPORHCS), 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 Veterans Affairs Portland Healthcare System (VAPORHCS) under the referenced first notice.
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 first notice. 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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