A10 IHS IEE Representation Form_Jan 2022.pdf
PDF 129 KB Posted
- Attached to
- Crow Creek Scattered Water and Sewer
- Solicitation number
- 75H70122R00071
About this file
This document provides details for a federal contract opportunity to construct individual and community water and sewer facilities on the Crow Creek Indian Reservation in South Dakota. The Indian Health Service is seeking information from interested parties to determine if this acquisition can be set aside as a 100% small business competition or a 100% Indian Economic Enterprise set aside. Responses are due by July 21, 2022.
The scope of work involves constructing water and sewer lines and facilities to serve ten individual home sites. Services required include installing water lines, septic tanks, absorption beds, and related infrastructure. The anticipated project value is between $250,000 and $500,000. Interested parties must submit responses using an attached questionnaire providing company and bonding information, experience on similar projects, and whether they will submit a proposal if a solicitation is issued. The solicitation is expected to be released by the end of July 2022 with proposals due at least 30 days later.
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Other files
| File | Type | Posted |
|---|---|---|
| A10 Sources Sought Submittal Questionnaire.docx | DOCX document |
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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: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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