BIA - Certification.pdf
PDF 204 KB Posted
- Attached to
- P/T Youth Psychologist - King William, VA
- Solicitation number
- 75H71524Q00011
About this file
This document is an Indian Economic Enterprise Representation Form for a federal solicitation or sources sought notice. It outlines the requirements for an offeror to self-certify that it meets the definition of an "Indian Economic Enterprise" under the Buy Indian Act in order to be eligible for a set-aside or sole source contract award. The form requires the offeror to provide the name of the Federally Recognized Tribal Entity and the 51% owner, as well as the business name and Unique Entity ID number. It states that the enterprise must meet the definition throughout the offer, award, and contract performance periods, and that false or misleading information is punishable by law.
The related federal contract opportunity is for a fixed-price purchase order to provide psychological services, including intake assessments, individual and family therapy, crisis intervention, consultation, and case management, for a Youth Psychologist position in King William, Virginia. The services are to be provided two days every other week, with direct care on Wednesdays and documentation/case management on Thursdays. The solicitation number is 75H71524Q00011, and the contracting agency is the Department of Health and Human Services Indian Health Service.
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Text version
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. 100 l.
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 Federally Recognized Tribal Entity Name of the 51% owner of ISBEE
Business Name Certifying Signature
Unique Entity ID Number Print Name
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service Office of Management Services Division of Acquisition Policy (DAP) 5600 Fishers Lane Rockville, MD 20857
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