A10 Attachment 1 IHS IEE Representation Form_Jan 2022.pdf
PDF 141 KB Posted
- Attached to
- Belcourt Replace Steam Boiler Design Build
- Solicitation number
- 75H70124R00031
About this file
This document is an Indian Health Service (IHS) sources sought notice for a construction project to replace a steam boiler in Belcourt, North Dakota. The project scope includes designing a new packaged steam boiler, demolishing the existing boiler, and installing the new boiler with integration into the existing steam piping system. The anticipated project value is between $250,000 and $500,000.
IHS is seeking responses from Indian Economic Enterprises (IEEs) and other small businesses, including 8(a), HUBZone, SDVOSB, WOSB, and SB firms. Respondents must provide company information, SAM UEI code, intent to bid, business type, bonding capacity, and relevant project experience. Native American-owned IEE firms must submit a completed IHS IEE Representation Form. Responses are due by April 12, 2024 and should be emailed to the Contract Specialist. No proposals are being requested at this time, as this is a sources sought notice to identify qualified firms.
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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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