IEE_Representation.pdf

DEPARTMENT OF HEALTH & HUMAN SERVICES Indian Owned Economic Enterprise INDIAN HEALTH SERVICE Representation

(July 2013)

Solicitation / Contract No.:______________________________

Project No. / Project Title: ______________________________

Date: _______________________

In accordance with 48 CFR 1452.280‐4, Indian economic enterprise representation, the signature below constitutes self‐certification that the offeror meets the definition of “Indian Owned Economic

Enterprise”, as defined in 48 CFR 1480.201, in response to the solicitation and resultant contract, in accordance with 25 U.S.C. 47 the Buy‐Indian Act. The enterprise must meet the definition of “Indian‐

Owned Economic Enterprise” throughout the following time periods: (1) At the time an offer is made in response to a solicitation, (2) At the time of contract award; and (3) During the full term of the contract performance period. At any point during these time periods, if the contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting

Officer.

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

1452‐280‐4 INDIAN ECONOMIC ENTERPRISE REPRESENTATION (JUL 2013)

Prescription: 1480‐801(a)

Provision: The offeror represents as part of its offer that is [ ] does, [ ] does not meet the definition of Indian Economic Enterprise as defined in 1480.201.

(Legal Business Name) (Certifying Signature)

(Dun & Bradstreet Number) (Printed Name)

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