B11 - IEE Representation.pdf
PDF 142 KB Posted
- Attached to
- Purchase of Flea and Tick Dog Collars
- Solicitation number
- 75H71425Q00003
About this file
This is an Indian Economic Enterprise (IEE) Representation Form issued by the Indian Health Service (IHS), Department of Health & Human Services, for use with solicitation #75H71425Q00003 for Flea and Tick Dog Collars.
The form requires offerors to self-certify that they meet the definition of an "Indian Economic Enterprise" under the Buy Indian Act (25 U.S.C. 47) throughout three key periods: when submitting the offer, at contract award, and during the full contract performance period. Offerors must indicate whether they do or do not meet the IEE definition, provide details about their 51% Indian ownership, include their business name, UEI SAM number, and federally recognized tribal entity affiliation. The form warns that false certifications are punishable under federal law and requires registration in the System for Award Management (SAM). This certification is specifically tied to a set-aside procurement for flea and tick dog collars to support the Tucson Area Environmental Health Service Branch Program's public health prevention efforts with the Pascua Yaqui Tribe.
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Other files
| File | Type | Posted |
|---|---|---|
| 75H71425Q00003 Amendment 0003.pdf | ||
| 75H71425Q00003 Amendment 0002.pdf | ||
| Amend 0001 Dog Collars.pdf | ||
| Terms and Conditions 121224.docx | DOCX document | |
| SOW Flea and Tick Dog Collars - 111424.docx | DOCX document | |
| Instructions to Offerors.docx | DOCX document | |
| 75H71425Q00003 SF1449.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
UEI SAM Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: 75H71425Q00003 |
| PROJECT_TITLE: Purchase of Flea and Tick Dog Collars |
| DoesNot: 0 |
| Does: Off |
File details come from the government source that posted it. Updated .