D.4 Organizational Conflict of Interest.pdf
PDF 126 KB Posted
- Attached to
- Q515--ON-SITE/OFF-SITE Pathology Services/589A7 Federal contract opportunity
- Solicitation number
- 36C25525Q0096_1
About this file
This is an Organizational Conflict of Interest (OCI) certification form for solicitation #36C25525Q0096 related to On-site/Off-site Pathology Services at the Robert J. Dole VA Medical Center.
The form requires contractors to certify one of two options: either 1) confirm that no individuals involved in the solicitation have any present, past, or planned interests (financial, contractual, organizational) that would constitute a conflict of interest, or 2) provide a detailed statement describing any relevant past, present, or planned interests that could create potential conflicts, including information about consultants and subcontractors. For option 2, contractors must also explain how their organizational/management systems would avoid or mitigate any potential conflicts. The form requires signature by a certifying official with title and date.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25525Q0096_1.docx | DOCX document | |
| D.2 Quality Assurance Surveillance Program QASP.docx | DOCX document | |
| D.5 Immigration and Nationality Act.pdf | ||
| D.7 Wage Determination 2015-5341 rev 27 7-22-2024.docx.pdf | ||
| D.8 BYLAWS Robert J Dole VAMC June 2023.pdf | ||
| D.1 Price Schedule.xlsx | XLSX spreadsheet | |
| D.3 Contractor Rules of Behavior.pdf | ||
| D.6 Past Performance References.pdf |
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Text version
Organizational Conflict of Interest
CONTRACTOR NAME:
ADDRESS:
SOLICITATION # 36C25525Q0096
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____ ________________ represents that no individuals involved with the solicitation 36C25525Q0096 for On-site/Off-site Pathology 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 Robert J. Dole VA Medical Center (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 Robert J. Dole 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
| CONTRACTOR NAME: |
| ADDRESS: |
| NAME OF CERTIFYING OFFICIALTITLE: |
| Contractor Name 2: |
| Check Box1: Off |
| Check Box2: Off |
| Date: |
File details come from the government source that posted it. Updated .