Attachment 3 - IHS IEE Representation Form.pdf
PDF 80 KB Posted
- Attached to
- Western Oregon Service Unit Interpreter Service
- Solicitation number
- 75H71326Q00056
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form used for federal contract solicitations, sources sought notices, and requests for information.
The form is a self-certification document for Solicitation 75H71326Q00056 issued June 18, 2026, for American Sign Language (ASL) Interpreter Services. Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with Indian ownership as defined under 25 U.S.C. 47 and HHSAR 326.601. Enterprises must maintain eligibility status at three critical junctures: when submitting an offer, at the time of contract award, and throughout the full contract performance period. Any loss of eligibility requires immediate written notification to the Contracting Officer. Contracting Officers may require 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 register with the System of Award Management (SAM). The form requires submission of the federally recognized tribal entity name, 51% owner name, business name, DUNS number, and certifying signature. False or misleading information submitted in support of a Buy Indian Act set-aside award violates federal law and is punishable under 18 U.S.C. 1001, while 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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| Attachment 2 - Performance Work Statement.pdf | ||
| Attachment 4 - Wage Determination 2015-5573 Rev. 28.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
75H71326Q00056
American Sign Language (ASL) Interpreter Services
June 18, 2026
File details come from the government source that posted it. Updated .