Attachment 2 - IEE Representation Form.pdf
PDF 955 KB Posted
- Attached to
- OIT Clinical Data Mart Operations and Maintenance (CDM) Federal contract opportunity
- Solicitation number
- 75H70426Q00030
About this file
This is an Indian Economic Enterprise Representation Form issued by the Department of Health and Human Services, Indian Health Service, Office of Management Services, Division of Acquisition Policy for Solicitation 75H70426Q00030 titled "OIT Clinical Data Mart Operations and Maintenance (CDM)."
The form requires vendors to self-certify their eligibility as an Indian Economic Enterprise under the Buy Indian Act (25 U.S.C. 47) and HHSAR 326.601. Offerors must meet the definition of Indian Economic Enterprise with Indian Ownership at three critical junctures: when submitting an offer, at contract award, and throughout the entire contract performance period. Any change in eligibility status during these periods requires immediate written notification to the Contracting Officer. Individual Contracting Officers may request documentation of eligibility before awarding set-aside or sole source contracts, and awards are subject to protest if the successful offeror's eligibility is questioned. Successful offerors must also maintain registration with the System of Award Management (SAM). The form serves as a template requiring completion of fields identifying the federally recognized tribal entity, business name, 51% owner of the Indian Economic Enterprise firm, Unique Entity Identifier (UEI) number, and a certifying signature. False or misleading information submitted in response to a Buy Indian Act set-aside is punishable under 18 U.S.C. 1001, and false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 1 - Performance Work Statement.pdf | ||
| Sources Sought Notice DCM.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 enterprise 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 a 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 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
Unique Entity Identifier (UEI) Number
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: 75H70426Q00030 |
| PROJECT_TITLE: OIT Clinical Data Mart Operations and Maintenance (CDM) |
| DoesNot: 0 |
| Does: Off |
| Date1_af_date: |
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