D.3 ORG CONFLICT CERT.pdf
PDF 84 KB Posted
- Solicitation number
- 36C26324Q0440
About this file
This document contains an organizational conflict of interest certification statement template for a solicitation seeking local offsite ophthalmology physician services in Des Moines, Iowa. The solicitation is a 5-year single-award IDIQ opportunity issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23. Key and temporary personnel supporting the opportunity are required to disclose any past, present or planned financial, contractual, organizational or other interests that could present a conflict relating to the services solicited. Offerors must also disclose any potential conflicts involving proposed consultants or subcontractors. The certification statement requires the offeror to either attest that no conflicts exist or provide a concise description of any relevant conflicts including proposed mitigation. Questions regarding the solicitation are due 72 hours before the date stipulated in block 8 of the SF1449 form and should be emailed to the address provided.
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Other files
| File | Type | Posted |
|---|---|---|
| D.1 QASP.pdf | ||
| D.5 Contractor Rules of Behavior.pdf | ||
| D.4 Key Personnel Tracker.xlsx | XLSX spreadsheet | |
| D.2 IMMIGRAT CERT.pdf | ||
| 36C26324Q0440.pdf | ||
| 36C26324Q0440_1.docx | DOCX document |
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ATTACHMENT D.3 OF RFQ 36C26324Q0440
852.209-70. ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)
All healthcare contracts require 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)
ATTACHMENT D.3 OF RFQ 36C26324Q0440
APPENDIX A
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION #
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 [____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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