D.6 - Attachment 6 - Organizational Conflict of Interest.pdf
PDF 232 KB Posted
- Attached to
- Q501--CRNA Services - MPLS Federal contract opportunity
- Solicitation number
- 36C26322R0119
About this file
This document is an organizational conflict of interest certification statement for solicitation number 36C26322R0119 for CRNA services at the Minneapolis VA Health Care System. The contractor must disclose any past, present, or currently planned interests or conflicts of interest, financial, contractual, organizational, or otherwise relating to providing the services requested in the solicitation. This includes interests or conflicts of any consultants, subcontractors, or key personnel identified in the contractor's proposal. The contractor must also describe any actions taken to avoid or mitigate potential organizational conflicts of interest. The certification must be signed and dated by an authorized official of the contractor. The related federal contract opportunity is for CRNA services at the Minneapolis VA Health Care System through the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| D.4 - Attachment 4 - Immigration and Nationality Act requirement.pdf | ||
| D.2 - Attachment 2 - Background Investigation Procedure and Documents.pdf | ||
| D.5 - Attachment 5 - VA Handbook 6500.6.pdf | ||
| D.3 - Attachment 3 - QASP.pdf | ||
| S02 - 36C26322R0119.pdf | ||
| D.1 - Attachment 1 - VA Rules and Behavior.pdf | ||
| 36C26322R0119_1.docx | DOCX document |
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Text version
D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26322R0119, CRNA Services, Minneapolis VAHCS
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _____________________(Contractor Name) represents that the individuals listed in the Key Personnel section of the solicitation 36C26322R0119, CRNA Services, 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 Minneapolis VA Health Care System 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 Minneapolis VA Health Care System 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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