D.6 - Organizational Conflict of Interest.pdf
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- Solicitation number
- 36C26324R0009
About this file
This document is a Contractor Conflict of Interest Certification Statement for Solicitation #36C26324R0009 for Certified Registered Nurse Anesthetist (CRNA) Services at the Minneapolis VA Health Care System.
The contractor certifies that the individuals listed as key personnel have no present, planned, or past interests (financial, contractual, organizational, or otherwise) that would create an actual or potential organizational conflict of interest relating to the CRNA services to be provided under this solicitation. If the contractor has any such interests, they are required to provide a statement describing the relevant facts. The contractor must also provide the same information for any consultants and subcontractors identified in the proposal. The solicitation period is from 10/17/2024 to 10/16/2025 with two option years.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26324R0009 0003.pdf | ||
| 36C26324R0009_4.docx | DOCX document | |
| 36C26324R0009_3.docx | DOCX document | |
| 36C26324R0009 0002.pdf | ||
| 36C26324R0009 0001.pdf | ||
| 36C26324R0009_2.docx | DOCX document | |
| D.3 - Quality Assurance Surveillance Plan.pdf | ||
| D.4 - Immigration and Nationality Act Requirement.pdf | ||
| 36C26324R0009_1.docx | DOCX document | |
| D.1 - VA Rules of Behavior.pdf | ||
| D.5 - VA Handbook 6500.6.pdf | ||
| D.2 - Background Investigation Procedure and Documents.pdf | ||
| S02 - 36C26324R0009.pdf |
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Text version
D.6 – Attachment 6 – Organizational Conflicts of Interest
[CONTRACTOR NAME]
[ADDRESS]
SOLICITATION # 36C26324R0009, 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 36C26324R0009, 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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