A10 Attachment 1 IHS IEE Representation Form.pdf
PDF 3 MB Posted
- Attached to
- Parker Pharmacy Clean Room (Parker, AZ)
- Solicitation number
- 75H701-25-R-00072
About this file
The document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for Solicitation Number 75H701-25-R-00072, relating to the Parker Pharmacy Clean Room project in Parker, Arizona. The form is a self-certification document for Native American-owned businesses to demonstrate eligibility for a construction project involving a pharmacy remodel with sterile and hazardous compounding rooms, adhering to United States Pharmacopeia (USP) 797 & 800 standards.
The project involves remodeling the Parker Indian Health Center pharmacy, with a total period of performance of 420 calendar days and an estimated project value between $1,000,000 and $5,000,000. The solicitation is a Sources Sought/Request for Information (RFI) seeking capabilities from small businesses, with a particular emphasis on Native American/Indian-Owned Businesses (Indian Economic Enterprises). Responses must be submitted by email to Kelly Britton by 2:00 PM MST on August 7, 2025, and must include company information, point of contact details, business type, bond capacity, and project experience requirements. The procurement will be categorized under PSC code Y1DA (Construction of Hospitals and Infirmaries) and NAICS code 236220 (Commercial and Industrial Building Construction).
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| File | Type | Posted |
|---|---|---|
| Attachment 1 IHS IEE Representation Form.pdf |
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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: 75H701-25-R-00072 |
| PROJECT_TITLE: Parker Pharmacy Clean Room |
| DoesNot: 0 |
| Does: Off |
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