IHS IEE Representation Form.pdf
PDF 130 KB Posted
- Attached to
- Non-Personal Health Care Services – Registered Nursing Services for the OB/GYN Department
- Solicitation number
- 75H71025Q00054_2
About this file
This is an Indian Economic Enterprise (IEE) Representation Form issued by the Indian Health Service (IHS), Department of Health & Human Services, for use with Buy Indian Act set-aside procurements. The form requires offerors to self-certify their status as an Indian Economic Enterprise, confirming they meet the eligibility requirements of 51% Indian ownership at the time of offer submission, contract award, and throughout contract performance. The form requires details including the solicitation number, project title, business name, UEI number, name of the 51% owner, and name of the Federally Recognized Tribal Entity.
This specific form relates to solicitation 75H71025Q00054_2 for Registered Nursing Services at the IHS Shiprock Service Unit's Northern Navajo Medical Center in New Mexico. The opportunity seeks three registered nurse positions for the OB/GYN Department, with a base period of 6 months plus one 6-month option period. Set aside for Indian Small Business Economic Enterprises (ISBEE) under NAICS 561320 (Temporary Help Services), quotes are due January 14, 2025. Offerors may submit up to five candidates per position, and evaluation will consider technical capability, education requirements, certifications, past performance, and price.
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Other files
| File | Type | Posted |
|---|---|---|
| 12. Sol_75H71025Q00054.pdf | ||
| 3. PWS.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
UEI Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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