D.6 - Organizational Conflict of Interest.pdf
PDF 449 KB Posted
- Attached to
- Mobile MRI with Staffing Federal contract opportunity
- Solicitation number
- 36C26322R0079
About this file
This document is an organizational conflict of interest certification statement for a federal contract solicitation to provide mobile MRI and MRI assistant staffing services to the Minneapolis VA Healthcare System. The solicitation number is 36C26322R0079 and seeks to acquire mobile MRI equipment and staffing assistance from contractors. Offerors must disclose any past, present or planned interests or conflicts relating to the services required under the solicitation for both the firm and any identified consultants or subcontractors. Contractors must either certify that no conflicts exist or provide a statement describing any relevant conflicts and how they would be avoided or mitigated. The certification must be signed and dated by an authorized official of the contracting firm.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| D.4 - Immigration and Nationality Act requirement.pdf | ||
| D.1 - VA Rules and Behavior.pdf | ||
| D.3 - QASP.pdf | ||
| S02 - 36C26322R0079 - 2-28-22.pdf | ||
| D.5 - VA Handbook 6500.6.pdf | ||
| D.2 - Background Investigation Procedure and Documents.pdf |
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Text version
D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26322R0079, Mobile MRI and MRI Assistant Staffing, for the Minneapolis VA Healthcare System (MVAHCS).
CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT
[ ] _____________________(Contractor Name) represents that the individuals listed in the Key Personnel section of the solicitation 36C26322R0079, Mobile MRI and MRI Assistant Staffing, 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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