A13_-_BSR_IEE_Representation.pdf

PDF 376 KB Posted

Attached to
Qtrs Renovation Havasupai Federal contract opportunity
Solicitation number
140A2326R0008
Issued by
Department of the Interior Bureau of Indian Affairs Bureau of Indian Education

About this file

The document is an Indian Economic Enterprise Representation form from the United States Department of the Interior, dated July 2013. It is a self-certification document that requires businesses to confirm they meet the definition of an "Indian economic enterprise" as defined in 1480.201, in accordance with the Buy Indian Act. The form mandates that an enterprise must maintain eligibility throughout three key periods: when an offer is submitted, at contract award, and during the full contract term.

The form warns that submitting false or misleading information is a violation of law, potentially punishable under 18 U.S.C. 1001 and subject to penalties outlined in 31 U.S.C. 3729-3731 and 18 U.S.C. 287. If an enterprise no longer meets the eligibility requirements at any point, they are required to provide immediate written notification to the Contracting Officer. The document provides space for a business name, certifying signature, and printed name, but no specific solicitation or contract number is filled in on this template.

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UUNNIITTEEDD SSTTAATTEESS

DDEEPPAARRTTMMEENNTT OOFF TTHHEE IINNTTEERRIIOORR

IInnddiiaann EEccoonnoommiicc EEnntteerrpprriissee RReepprreesseennttaattiioonn ((JJUULL

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PPrroojjeecctt NNoo.. __NN//AA____________________________________

DDaattee:: ______________________

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((BBuussiinneessss NNaammee)) ((CCeerrttiiffyyiinngg SSiiggnnaattuurree))

((PPrriinntt NNaammee))

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