ATTACHMENT D.2 - CONFLICT OF INTEREST.pdf
PDF 632 KB Posted
- Attached to
- Q519-- Psychiatrist Services Federal contract opportunity
- Solicitation number
- 5802032180010
About this file
This document includes an attachment and solicitation for onsite psychiatrist services. The Department of Veterans Affairs Network Contracting Office 16 is seeking quotes for onsite psychiatrist services to eligible beneficiaries at the Michael E. DeBakey VA Medical Center in Houston, Texas and its nine community-based outpatient clinics. Services shall be provided onsite at these locations. The solicitation also includes two future outpatient clinic locations. Quotes are required for NAICS 561320, Temporary Help Services with a size standard of $30 million. This procurement is set aside for Service-Disabled Veteran Owned Small Businesses registered in the System for Award Management and Vendor Information Pages. Interested parties must submit the required information by the response due date listed in the solicitation to be considered.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25620Q0622 0002.docx | DOCX document | |
| 36C25620Q0622 0001.docx | DOCX document | |
| ATTACHMENT D.3 - CONTRACTOR CERTIFICATION-IMMIGRATION CERTIFICATION.pdf | ||
| ATTACHMENT D.1 -QASP.pdf | ||
| RFQ - 36C25620Q0622- PSYCHIATRIST SERVICES HOUSTON_TX.pdf | ||
| ATTACHMENT D.4 - PAST PERFORMANCE REFERENCES.pdf | ||
| ATTACHMENT D.5 - PAST PERFORMANCE QUESTIONNAIRE.pdf |
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Text version
ATTACHMENT D.3 – 36C25620Q0622 – Psychiatrist Physician Services
Insert Contractor Name and Address Below:
SOLICITATION # 36C25620Q0622
CONFLICT OF INTEREST
[ ] Insert Contractor Name Here To Replace Red Text, represents that the individuals listed in the Key Personnel and Temporary Emergency Substitutions section of the solicitation 3625620Q0622 for on-site Psychiatry Care Services 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 Michael E. DeBakey VA Medical Center, nine (9) CBOCs and/or its two (2) future outpatient clinics, 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
Michael E. DeBakey VA Medical Center, nine (9) CBOCs and/or its two (2) future outpatient clinics, 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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