D.2 ORGANIZATIONAL CONFLICT OF INTEREST.pdf
PDF 307 KB Posted
- Solicitation number
- 36C25526Q0064
About this file
This document is an Organizational Conflict of Interest (OCI) Certification Statement for Solicitation #36C25526Q0064 with the Veterans Administration Medical Center (VAMC). The form provides two options for contractors: 1) certify that no individuals involved have any past, present, or planned financial, contractual, organizational, or other conflicts of interest related to the services, or 2) attach a detailed statement describing any potential conflicts of interest. The form requires the contractor to disclose potential conflicts for their organization, employees, consultants, and subcontractors, and offers an opportunity to explain how they would mitigate any identified conflicts. The document includes spaces for the name of the certifying official, their title, signature, and date of certification.
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Other files
| File | Type | Posted |
|---|---|---|
| D.4 CONTRACTOR RULES OF BEHAVIOR.pdf | ||
| D.7 WAGE DETERMINATIONS.pdf | ||
| D.6 SMALL BUSINESS SUBCONTRCTING PLAN TEMPLATE.pdf | ||
| D.5 CONTRACTOR CERTIFICATION IMMIGRATION AND NATIONALITY ACT.pdf | ||
| D.1 QASP.pdf | ||
| 36C25526Q0064.docx | DOCX document | |
| D.3 PAST PERFORMANCE CONTACTS.pdf |
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Text version
Organizational Conflict of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C25526Q0064
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
Attachment D.2 Organizational Conflict of Interest
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