B01 Attachment J06 IHS IEE Representation Form.pdf
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- Solicitation number
- 75H70125R00039
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for Solicitation Number 75H70125R00039, the Billings Area Generator Project. The form requires potential offerors to self-certify whether they meet the definition of an "Indian Economic Enterprise" with Indian Ownership under the Buy Indian Act, which mandates that the enterprise must maintain eligibility at the time of offer, contract award, and throughout the entire contract performance period.
The associated solicitation is for a 100% Small Business set-aside construction project to provide backup emergency generators at three health care facilities in Montana and Wyoming: Verne E. Gibbs Health Center (Poplar, MT), Pryor Health Station (Pryor, MT), and Arapahoe Health Center (Arapahoe, WY). The project involves installing emergency generators capable of providing backup power for up to 96 hours, supporting critical medical equipment, lighting, and HVAC systems. The contract will be a Firm Fixed Price (FFP) construction contract with a 180-calendar day performance period, and the project's estimated value ranges between $1,000,000 and $5,000,000. Award will be based on the lowest price technically acceptable proposal (LPTA) methodology.
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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: 75H70125R00039 |
| PROJECT_TITLE: Billings Area (Poplar, MT / Pryor, MT / Arapahoe, WY) Generator Project |
| DoesNot: 0 |
| Does: Off |
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