D.5 ORGANIZATIONAL CONFLICT OF INTEREST.pdf
PDF 214 KB Posted
- Attached to
- Q401--On-Site HEMODIALYSIS, WI
- Solicitation number
- 36C25525Q0419
About this file
This document is a federal contract opportunity's Organizational Conflict of Interest (OCI) form for a VA hemodialysis services solicitation. The form requires potential contractors to disclose any past, present, or planned interests that could create a conflict of interest when providing services to the Robert J. Dole VAMC in Wichita, Kansas. Contractors must complete a certification statement indicating either no conflicts exist or providing a detailed explanation of potential conflicts, with the understanding that nondisclosure or misrepresentation could result in contract termination. The form is part of solicitation 36C25525Q0419 for on-site acute/chronic hemodialysis services, and requires contractors to transparently report any circumstances that might impair their ability to impartially assist the government or provide an unfair competitive advantage.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25525Q0419.docx | DOCX document | |
| D.4 IMMIGRAT CERT.pdf | ||
| D.3 WAGE DETERMINATION 5341 29 6-4-25.pdf | ||
| D.7 BYLAWS ROBERT J. DOLE VAMC.pdf | ||
| D.6 RULES OF BEHAVIOR FOR ORGANIZATIONAL USERS.pdf | ||
| D.2 SMALL BUSINESS SUBCONTRCTING PLAN TEMPLATE.pdf | ||
| D.8 PAST PERFORMANCE QUESTIONNAIRE.pdf | ||
| D.1 QASP.pdf |
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Text version
D.3 ORGANIZATIONAL CONFLICTS OF INTEREST 36C25525R0001
ORGANIZATIONAL CONFLICTS OF INTEREST
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
(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.
D.3 ORGANIZATIONAL CONFLICTS OF INTEREST 36C25525R0001
Organizational Conflict of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C25525Q0419
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] ____[CONTRACTOR NAME]________________ represents that no individuals involved with the solicitation [Solicitation # 36C25525Q0419 and General Surgery 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 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
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