Attachment 1--IEE Representation Form.pdf

PDF 3 MB Posted

Attached to
ISBEE-CISCO Network Equipment and Software Maintenance Federal contract opportunity
Solicitation number
75H70424Q00047
Issued by
Department of Health and Human Services Indian Health Service

About this file

This document is an Indian Economic Enterprise (IEE) Representation Form related to a federal contract opportunity. The form indicates that the solicitation is set-aside for Indian Small Business Economic Enterprises (ISBEEs) under the Buy Indian Act, with the NAICS code 541519 (Information Technology Value Added Resellers) and a size standard of 150 employees. The contract is for Cisco network equipment and software maintenance, and the solicitation number is 75H70424Q00047. The form requires the offeror to self-certify that it meets the definition of an "Indian Economic Enterprise" at the time of offer, award, and throughout the contract performance period. Failure to maintain eligibility or providing false information can result in legal penalties. The contracting agency is the Indian Health Service (IHS), Department of Health and Human Services.

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Other files for this federal contract opportunity

Other files attached to ISBEE-CISCO Network Equipment and Software Maintenance, newest first.
File Type Posted
Amendment 00001-Q_A RFQ 75H70424Q00047.pdf PDF
Attachment 5--52.212-5.pdf PDF
Attachment 3--SOW Cisco Network Equipment Maintenance.pdf PDF
Attachment 2--Equipment List.xlsx XLSX spreadsheet
Attachment 4--BNJ.pdf PDF
Attachment 6--Additional Provisions_Clauses.pdf PDF
Combined-Synopsis RFQ 75H70424Q00047.pdf 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: 75H70424Q00047
PROJECT_TITLE: Cisco Network Equipment and Software Maintenance
DoesNot: 0
Does: Off

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