D.6 Organizational Conflict of Interest.pdf
PDF 141 KB Posted
- Attached to
- Q501--CRNA Services Federal contract opportunity
- Solicitation number
- 36C26322R0006
About this file
This document is an organizational conflict of interest certification statement template for solicitation number 36C26322R0006 for Certified Registered Nurse Anesthetist services at the St. Cloud Veterans Affairs Health Care System. The template requires the contractor to certify that its key personnel listed in the solicitation do not have any present, planned, or past financial, contractual, organizational, or other conflicts of interest relating to providing the solicited services. If conflicts exist, the contractor must provide a statement describing all relevant facts. The contractor must also provide conflict of interest statements for any consultants or subcontractors. The solicitation is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 23 to provide CRNA services.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| D.5 VA Handbook 6500.6.pdf | ||
| 36C26322R0006.pdf | ||
| D.2 Background Investigation Procedure and Documents.pdf | ||
| D.4 Immigration and Nationality Act Requirement.pdf | ||
| D.3 QASP.pdf | ||
| D.1 VA Rules of Behavior.pdf | ||
| 36C26322R0006_1.docx | DOCX document |
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Text version
D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26322R0006, Certified Registered Nurse Anesthetist Services, St. Cloud STCVAHCS
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _____________________(Contractor Name) represents that the individuals listed in the Key Personnel section of the solicitation 36C26322R0006, Certified Registered Nurse Anesthetist 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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