S02 D.5 Organizational Conflicts of Interest.docx

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G004--HCHV - Emergency Residential Placement, estimated 4 Beds per day Big Spring, TX
Solicitation number
36C25725Q0073
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This document is an Organizational Conflicts of Interest (OCI) certification form for VA Solicitation 36C25725Q0073, which involves an Emergency Residential Placement contract for the West Texas VA Health Care System in Big Spring, TX. The form requires potential contractors to disclose any past, present, or planned financial, contractual, organizational, or other interests that could create a conflict of interest when providing services. Contractors must either certify no conflicts exist or provide a detailed statement describing potential conflicts, with the understanding that undisclosed or misrepresented conflicts may result in contract termination. The solicitation is for an estimated 4 beds per day of emergency residential placement services, targeting veterans through the Veterans Health Administration's Veterans Integrated Service Network 17.

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WD 2015-5269 Rev 28 dated 5.15.2025.pdf PDF
36C25725Q0073 0005.docx DOCX document
36C25725Q0073 0004.docx DOCX document
36C25725Q0073 0003.docx DOCX document
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36C25725Q0073 0001.docx DOCX document
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852.209-70. ORGANIZATIONAL CONFLICTS OF INTEREST (OCT 2020)

RFQ 36C25725Q0073

All healthcare contracts require response to the following provision as prescribed in VAAR 809.507-1(b).

(a) It is in the best interest of the Government to avoid situations which might create an organizational conflict of interest or where the Offeror’s performance of work under the contract may provide the Contractor with an unfair competitive advantage. The term “organizational conflict of interest” means that because of other activities or relationships with other persons, a person is unable to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is or might be otherwise impaired, or the person has an unfair competitive advantage.

(b) The Offeror shall provide a statement with its offer which describes, 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.

(c) Based on this information and any other information solicited or obtained by the Contracting Officer, the Contracting Officer may determine that an organizational conflict of interest exists which would warrant disqualifying the Contractor for award of the contract unless the organizational conflict of interest can be mitigated to the Contracting Officer's satisfaction by negotiating terms and conditions of the contract to that effect. If the conflict of interest cannot be mitigated and if the Contracting Officer finds that it is in the best interest of the United States to award the contract, the Contracting Officer shall request a waiver in accordance with FAR 9.503.

(d) Nondisclosure or misrepresentation of actual or potential organizational conflicts of interest at the time of the offer or arising as a result of a modification to the contract, may result in the termination of the contract at no expense to the Government.

APPENDIX A

[CONTRACTOR NAME]

[ADDRESS]

SOLICITATION # 36C25725Q0073

CONTRACTOR CONFLICT OF INTEREST CERTIFICATION STATEMENT

[ ] ____[CONTRACTOR NAME]________________ represents that the individuals listed in the Key Personnel section of the solicitation # 36C25725Q0073 – Emergency Residential Placement - Big Spring, TX have not 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 West Texas VA Health Care System 300 W Veterans Blvd Big Spring, TX 79720 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 West Texas 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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