B01 Attachment J04 IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Rosebud Penthouse Mechanical Work - Construction Project Federal contract opportunity
- Solicitation number
- 75H70122R00022
About this file
This document includes an Indian Health Service solicitation notice and Indian Economic Enterprise representation form. The solicitation is for Rosebud Penthouse Mechanical Work construction project located in Rosebud, South Dakota. The scope of work involves demolishing and installing larger chilled water piping at four air handlers, demolishing and re-piping the condenser drain system, and raising existing cooling coils and drain pans. The period of performance is 180 calendar days from notice to proceed. The estimated value is between $100,000 and $250,000. A site visit is scheduled for March 30, 2022 and the solicitation will use lowest price technically acceptable evaluation. The representation form is to be completed by offerors self-certifying as an Indian Economic Enterprise in accordance with the Buy Indian Act.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B05 Amendment A00003.pdf | ||
| B05 Amendment A00002 - Attachment J01.pdf | ||
| B05 Amendment A00002 - SF30.pdf | ||
| B05 75H70122R0022 - Amendment A00001.pdf | ||
| B01 Attachment J01 - DRAWINGS_RB_PIPING_PROJ.pdf | ||
| B01 Attachment J06 - PPQ.docx | DOCX document | |
| B01 RFP - 75H70122R00022 3 18 2022.pdf | ||
| B01 Attachment J02 - Wage Rates Todd County SD 2 25 2022.pdf | ||
| B01 Attachment J03 - Self Performed Calculation Sheet (Construction).pdf | ||
| B01 Attachment J05 - Company Specialized Experience Form Construction.docx | DOCX document |
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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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