S02 - D.2 ATTACHMENT B - ORGANIZATIONAL CONFLICT OF INTEREST.docx
DOCX document 22 KB Posted
- Attached to
- R499--Clinical Microbiologist Services Federal contract opportunity
- Solicitation number
- 36C25222Q0568
About this file
This document is an organizational conflict of interest statement template for the solicitation number 36C25222Q0568 for Clinical Microbiologist Services. The solicitation is seeking offers for providing microbiologist services to the Veterans Health Administration Veterans Integrated Service Network 12. Offerors are required to disclose any past, present, or currently planned interests or conflicts of interest, including those of any consultants or subcontractors, relating to the services requested under the solicitation. Offerors may also provide information on how their organizational structure would avoid or mitigate any actual or potential conflicts of interest.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| S02 - D.3 ATTACHMENT C - CONTRACTOR IMMIGRATION CERTIFICATION.docx | DOCX document | |
| S02 - D.1 ATTACHMENT A - VHA SUPPLEMENTAL GUIDANCE COMBATTING COVID-19.docx | DOCX document | |
| 36C25222Q0568_2.docx | DOCX document |
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Text version
36C25222Q0568 Attachment B Organizational Conflict of Interest Statement
CONTRACTOR NAME: ____________________
CONTRACTOR ADDRESS: _____________________________________________________________
SOLICITATION # _____________________
[ ] [CONTRACTOR NAME]________________ represents that the individual(s) listed in the Price Schedule section of the solicitation #36C25222Q0568 for Microbiologist 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 VISN 12 Pathology & Laboratory Medicine Service (PLMS) under the referenced solicitation.
None of the contractor 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 VISN 12 PLMS 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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