D.5 ATTACHMENT E_AFFIRMATION STATEMENT.docx
DOCX document 24 KB Posted
- Solicitation number
- 36C10X26R0001
About this file
Attachment E is an affirmation statement for the Veterans Health Administration (VHA) Caregiver Support Program Financial and Legal Services solicitation (36C10X26R0001). The document requires offerors to certify two key commitments: (1) they will not receive additional financial gains from referrals beyond contract profit, and (2) they must maintain specific insurance coverage, including $300,000 annual malpractice insurance for attorneys and $1 million in miscellaneous professional liability insurance for financial services.
The related federal contract opportunity is a non-small business set-aside for legal services, specifically targeting financial and legal support for the VHA Caregiver Support Program. The solicitation, issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick, will result in a single contract award using NAICS Code 541110 (Office of Lawyers) with a small business size standard of $16 million. The solicitation is a combined synopsis/proposal request that does not require a separate written solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C10X26R0001 0003.pdf | ||
| D.10 ATTACHMENT K_PRICE SCHEDULE_Rev2.xlsx | XLSX spreadsheet | |
| 36C10X26R0001 0002.pdf | ||
| 36C10X26R0001 0001 B.pdf | ||
| D.10 ATTACHMENT K_PRICE SCHEDULE_Rev1.xlsx | XLSX spreadsheet | |
| D.10 ATTACHMENT K_PRICE SCHEDULE_Sept 30, 2025.xlsx | XLSX spreadsheet | |
| D.9 ATTACHMENT J - PAST PERFORMANCE QUESTIONAIRRE.docx | DOCX document | |
| D.4 ATTACHMENT D_LIMITATIONS ON SUBCONTRACTING_CERTIFICATE FOR SERVICES.docx | DOCX document | |
| D.1 ATTACHMENT A - VA CONTRACTOR BACKGROUND INVESTIGATION REQUEST WORKSHEET.pdf | ||
| D.8 ATTACHMENT H - PAST PERFORMANCE REFERENCES.pdf | ||
| 36C10X26R0001_1.docx | DOCX document | |
| D.7 ATTACHMENT G - WAGE DETERMINATION.docx | DOCX document | |
| D.6 ATTACHMENT F_BUSINESS ASSOCIATE AGREEMENT.pdf | ||
| D.3 ATTACHMENT C SAMPLE REFERRAL LANGUAGE_Sept 22, 2025.docx | DOCX document | |
| D.2 ATTACHMENT B - FY26 VA INFORMATION SECURITY RULES OF BEHAVIOR.pdf | ||
| 36C10X26R0001.pdf |
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Text version
D.5 ATTACHMENT E: AFFIRMATION OF NO ADDITIONAL FINANCIAL GAINS AND MAINTAINED ACTIVE INSURANCE
Certification:
As required by the Veterans Health Administration (VHA) Caregiver Support Program Financial and Legal Services solicitation, I hereby certify that if awarded the contract, [insert name of offeror] will not receive any financial gain, due to referrals for supplemental financial or legal services, beyond the profit realized as a result of the awarded.
Additionally, [insert name of offeror] must ensure that every licensed attorney supporting the contract maintains a minimum of $300,000.00 in annual malpractice insurance for legal services or the minimum required by each state, whichever is higher. In addition, the Contractor must maintain $1M miscellaneous professional liabilities insurance for financial services.
I further certify that I am authorized to execute this certification on behalf of [insert name of offeror].
Printed Name of Signee:________________________________________ Printed Title of Signee:_________________________________________ Signature:___________________________________________________ Date:_____________________ Company Name and Address:______________________________________
File details come from the government source that posted it. Updated .