A10 Attachment 1 IHS IEE Representation Form_Jan 2022.pdf
PDF 189 KB Posted
- Attached to
- Anthony Sanchez Replacement OSS (Nisqually) Federal contract opportunity
- Solicitation number
- 75H70124Q00016
About this file
This document contains an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form and details of a related federal contract opportunity. The Representation Form is a self-certification that the offeror meets the definition of an "Indian Economic Enterprise" as defined in the HHS Acquisition Regulation. It requires certification that the enterprise meets the definition at the time of offer, award, and throughout contract performance. It also requires registration with the System for Award Management.
The related federal contract opportunity is for the installation of an individual septic system on fee land located in Thurston County, Washington for a Nisqually Tribal member. The proposed septic system will include a sewer cleanout, 1,200 gallon two-compartment septic tank, 1,200 gallon pump chamber, effluent transport line, and a 600 square foot gravel bed drainfield with drain rock and topsoil. It will also abandon the existing septic tank. The solicitation number is 75H701-24-Q-00016 and it was issued by the Department of Health and Human Services Indian Health Service.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| A10 Sources Sought Template 2024-01-09.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: 75H701-24-Q-00016 |
| PROJECT_TITLE: Anthony Sanchez Replacement OSS (Nisqually) |
| DoesNot: 0 |
| Does: Off |
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