A5. IHS IEE Rep Form Dental Laboratory Services Bemidji Area.pdf
PDF 290 KB Posted
- Solicitation number
- 75H70527R00002
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form for a sources sought notice, request for information (RFI), or solicitation.
The form applies to solicitation/sources sought/RFI number 75H70527R00002 for Dental Laboratory Services for the Bemidji Area, dated November 2, 2026. Offerors must self-certify that they meet the definition of an "Indian Economic Enterprise" under 25 U.S.C. 47 (the Buy Indian Act) and HHSAR 326.601, with at least 51% ownership by a member of a Federally Recognized Tribal Entity. The enterprise must maintain this eligibility status at three critical points: when submitting an offer, at the time of contract award, and throughout the full contract performance period. Any loss of eligibility during these periods requires immediate written notification to the Contracting Officer. Successful offerors must also register with the System of Award Management (SAM). The form includes a representation section where offerors check a box to indicate whether they do or do not meet the Indian Economic Enterprise definition with Indian Ownership. Required fields include the name of the Federally Recognized Tribal Entity, business name, DUNS number, name of the 51% owner, and a certifying signature with printed name. The form warns that false or misleading information constitutes a violation under 18 U.S.C. 1001, and false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
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Other files
| File | Type | Posted |
|---|---|---|
| A1. Statement of Work Area dental lab services 11.2.26.docx | DOCX document | |
| A5. Sources Sought Dental Laboratory Services Bemidji Area.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 #: 75H70527R00002
PROJECT TITLE:Dental Laboratory Services for the Bemidji Area
DATE: 11/2/2026
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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