B01 Attachment J05 IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Northern Cheyenne Service Unit Flooring Replacement Project Federal contract opportunity
- Solicitation number
- 75H70122R00058
About this file
This document contains a pre-solicitation notice and Indian Economic Enterprise representation form for a construction project. The Northern Cheyenne Service Unit Flooring Replacement Project will replace carpeting and vinyl composition tile flooring at the facility in Lame Deer, Montana. The solicitation is expected to be released on June 23rd, with responses due within 30 days. The project scope involves demolishing existing flooring in hallways, corridors, and other areas before installing new luxury vinyl tile and carpet. A geometric morning star design will be added to the main lobby floor. The representation form is for offerors to indicate whether they meet the definition of an Indian Economic Enterprise under the Buy Indian Act. This pre-solicitation notice provides relevant details about the procurement, including the small business set-aside with preference for Indian Economic Enterprises, construction duration of 90 days, project magnitude between $250,000 to $500,000, and requirement for registration in the System for Award Management database.
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| B05 Amendment A00001 SF30 7 25 2022.pdf | ||
| B01 RFP 22R00058 NCSU Flooring Replacement.pdf | ||
| B01 Attachment J04 Technical Specifications.docx | DOCX document | |
| B01 Attachment J02 Wage Determination Rosebud County 2 25 2022.pdf | ||
| B01 Attachment J01 Self Performed Calculation Sheet (Construction).docx | DOCX document | |
| B01 Attachment J03 NCSU Clinic Final Drawings.pdf | ||
| B01 Attachment J06 PPQ.docx | DOCX document | |
| B01 Attachment J07 Company Specialized Experience Form Construction.docx | DOCX document |
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Office of Management Services Division of Acquisition Policy (DAP)
5600 Fishers Lane Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________
PROJECT TITLE: ________________________________________________________
DATE: ___________________________________________________________________
In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.
The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:
(1) At the time an offer is made in response to this solicitation;
(2) At the time of contract award; and
(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.
Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).
Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.
False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.
REPRESENTATION
The Offeror represents as part of its offer that it does _____, does not _____ meet the definition of an “Indian Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.
Name of the 51% owner of IEE Firm
Certifying Signature
Print Name
Name of Federally Recognized Tribal Entity
Business Name
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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