D.6 - Organizational Conflict of Interest.pdf
PDF 393 KB Posted
- Solicitation number
- 36C26322R0014
About this file
This document is an organizational conflict of interest certification statement template for solicitation number 36C26322R0014 for ophthalmology health technician services to be provided at the Rochester VA Clinic for the Minneapolis VAHCS. The contractor must disclose any past, present or planned interests or conflicts relating to the services to be provided, including those of any consultants or subcontractors. They must either certify that no such conflicts exist, or provide a statement describing any relevant conflicts in a concise manner. The services required are for ophthalmology health technicians at the Rochester VA Clinic for the Minneapolis VA Health Care System.
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Other files
| File | Type | Posted |
|---|---|---|
| D.2 - Background Investigation Procedure and Documents.pdf | ||
| D.4 - Immigration and Nationality Act requirement.pdf | ||
| D.1 - VA Rules and Behavior.pdf | ||
| 36C26322R0014_1.docx | DOCX document | |
| D.5 - VA Handbook 6500.6.pdf | ||
| D.3 - QASP.pdf | ||
| 36C26322R0014.pdf |
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Text version
D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26322R0014, Ophthalmology (Ophthalmic) Health Technician Services, for the Minneapolis VAHCS provided at the Rochester VA Clinic, 3551 Commercial Drive South West, Suite 400, Rochester, MN 55902
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _____________________(Contractor Name) represents that the individuals listed in the Key Personnel section of the solicitation 36C26322R0014, Ophthalmology (Ophthalmic) Health Technician 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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