A10 Attachment 1 IHS IEE Representation Form.pdf
PDF 1 MB Posted
- Attached to
- J. Jenkins OSS (COW)
- Solicitation number
- 75H70126Q00034
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form, issued by the Department of Health & Human Services, Office of Management Services, Division of Acquisition Policy.
The form is a self-certification document that offerors must complete to establish eligibility as an "Indian Economic Enterprise" (IEE) under the Buy Indian Act (25 U.S.C. 47) for solicitation 75H70126Q00034 related to the J. Jenkins OSS (COW) project. Offerors must certify that they meet the IEE definition with Indian ownership under the Buy Indian Act at three critical junctures: when submitting an offer, at the time of contract award, and throughout the full contract performance period. Any contractor that ceases to meet eligibility requirements during these periods must immediately notify the Contracting Officer in writing. The form requires the offeror to indicate whether it meets or does not meet the IEE definition and must be completed with the name of the Federally Recognized Tribal Entity, the 51% owner of the IEE firm, business name, DUNS number, certifying signature, and printed name. Successful offerors must also maintain registration in the System of Award Management (SAM). The form warns that false or misleading information submitted in connection with Buy Indian Act set-aside or sole source contract awards constitutes a violation of federal law under 18 U.S.C. 1001, with additional penalties for false claims during contract performance under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
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| File | Type | Posted |
|---|---|---|
| A10 Sources Sought Template.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: 75H70126Q00034 |
| PROJECT_TITLE: J. Jenkins OSS (COW) |
| DoesNot: 0 |
| Does: Off |
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