Atch H - IEE Representation Form.pdf
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- Attached to
- Physician Assistant/Nurse Practitioner Services at PCMC Federal contract opportunity
- Solicitation number
- RFP-22-PHX-11
About this file
This document includes a federal contract opportunity for physician assistant and nurse practitioner services at the Phoenix Indian Medical Center. The combined synopsis/solicitation is seeking firm fixed price proposals for non-personal professional nurse practitioner and physician assistant services in accordance with the attached statement of work. The period of performance is estimated from August 16, 2022 through August 15, 2023 with four option years. The place of performance is the Phoenix Indian Medical Center located in Phoenix, Arizona. The solicitation is set aside for Native American firms in accordance with the Buy Indian Act of 1910. Offerors must complete and submit the included Indian Economic Enterprise representation form. Proposals are due by email to the specified address by the closing date of May 26, 2022. The Department of Health and Human Services Indian Health Service will award a firm fixed price contract to the responsible and responsive offeror deemed to provide the best value based on price and other factors.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Atch D- Statement of Work -PCMC NP PA.pdf | ||
| Atch C - 2022 Tax Exemption.pdf | ||
| Atch B - Business Associate Agreement.pdf | ||
| Atch G - Clauses.Terms and Instructions.pdf | ||
| Atch F -Wage Determination 2015-5469 dtd 27 June 2022.pdf | ||
| Atch E - Timesheet for Contract Service.xlsx | XLSX spreadsheet | |
| Atch A - Rate Schedule PCMC NP.PA.xlsx | XLSX spreadsheet |
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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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