B01 Attachment J06 IHS IEE Representation Form.pdf
PDF 959 KB Posted
- Attached to
- Duplex Construction at Pine Ridge, Kyle, and Wanblee Federal contract opportunity
- Solicitation number
- 75H70125R00064
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form used for federal contracting opportunities. The form is specifically for solicitation/sources sought/RFI #75H70125R00064 for "Duplex Construction at Pine Ridge, Kyle, Wanblee," though the date field is blank.
The form requires offerors to self-certify whether they meet the definition of an "Indian Economic Enterprise" under 25 U.S.C. 47 and HHSAR 326.601. To qualify, enterprises must maintain eligibility throughout three critical periods: at time of offer submission, at contract award, and during the entire contract performance period. The form includes fields for the name of the 51% owner of the IEE firm, name of the federally recognized tribal entity, business name, DUNS number, and certification signature. Contracting officers may require additional documentation before awarding set-aside or sole source contracts under the Buy Indian Act, and successful offerors must be registered in the System of Award Management (SAM). The form warns that false or misleading information is punishable under federal law, with specific references to penalties under 18 U.S.C. 1001, 31 U.S.C. 3729-3731, and 18 U.S.C. 287.
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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: 75H70125R00064 |
| PROJECT_TITLE: Duplex Construction at Pine Ridge, Kyle, Wanblee |
| DoesNot: 0 |
| Does: Off |
File details come from the government source that posted it. Updated .