B01 Attachment J07 IHS IEE Representation Form.pdf
PDF 965 KB Posted
- Attached to
- Eagle Butte LED Efficient Lighting Federal contract opportunity
- Solicitation number
- 75H70125R00060
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for the Eagle Butte LED Efficient Lighting project (Solicitation #75H70125R00060). The form requires self-certification that an offeror meets the definition of an "Indian Economic Enterprise" with Indian ownership, which must be maintained from offer submission through contract performance. The form emphasizes that false or misleading information is a violation of law, punishable under federal statutes, and successful offerors must be registered in the System of Award Management (SAM).
The associated solicitation is for upgrading lighting at the Cheyenne River Health Center in Eagle Butte, South Dakota, involving the replacement of approximately 2,148 lights with modern LED fixtures, including removal of existing components like ballasts and lamp holders. The project is valued between $500,000 and $1,000,000, with a 270-calendar day performance period. It is a 100% set-aside for Indian Small Business Economic Enterprises under NAICS code 238210, with a $19 million size standard, and will be awarded as a Firm Fixed Price contract using Lowest Price Technically Acceptable evaluation criteria.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B05 75H70125R00060 Amendment 02.pdf | ||
| B05 75H70125R00060 Amendment 01.pdf | ||
| B03 Prebid Meeting Sign In.pdf | ||
| B01 Attachment J04 Wage Decision SD20250024.pdf | ||
| B01 Attachment J02 Light Schedule.pdf | ||
| B01 Attachment J03 Self Performed Calculation Sheet.docx | DOCX document | |
| B01 Attachment J01 Lighting Locations.pdf | ||
| B01 RFP 75H70125R00060.pdf | ||
| B01 Attachment J06 Past Performance Questionnaire.docx | DOCX document | |
| B01 Attachment J05 Company Specialized Experience Form.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: 75H70125R00060 |
| PROJECT_TITLE: Eagle Butte LED Efficient Lighting |
| DoesNot: 0 |
| Does: Off |
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