Attach 2 IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 129 KB Posted
- Attached to
- Notice of ISBEE Set-Aside: Immunization Coverage Reporting & Government Performance and Results Act (GPRA) Optimization Project Federal contract opportunity
- Solicitation number
- 7571PS26Q00058
About this file
This is a self-certification representation form issued by the Indian Health Service (IHS), Department of Health & Human Services, for enterprises seeking to qualify as "Indian Economic Enterprises" (IEEs) under the Buy Indian Act (25 U.S.C. 47).
The form requires offerors to self-certify their eligibility as Indian Economic Enterprises with Indian ownership in response to Sources Sought Notices, Requests for Information (RFIs), or solicitations. Enterprises must meet the IEE definition at three critical points: when submitting an offer, at the time of contract award, and throughout the full contract performance period. Any loss of eligibility during these periods requires immediate written notification to the Contracting Officer. The form specifies that successful offerors must also register with the System of Award Management (SAM) and that Contracting Officers may request documentation of eligibility before awarding set-aside or sole source contracts. The form warns that false or misleading information submitted in offers violates 18 U.S.C. 1001 and is subject to civil and criminal penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Offerors must indicate whether they meet or do not meet the IEE definition and provide the name of the federally recognized tribal entity, business name, 51% owner name, DUNS number, certifying signature, and printed name of the signatory.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amend 1_Answers to Questions.pdf | ||
| Attach 1 Pricing and Staffing Template.xlsx | XLSX spreadsheet | |
| RFQ 7571PS26Q00058.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: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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