B11 - IEE Representation.pdf
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- Attached to
- Sources Sought: Prescription Eyeglasses for the Billings Area Indian Health Service (BAIHS) Locations.
- Solicitation number
- SS-75H709-BAIHS25Q-012
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form designed to self-certify eligibility for contract opportunities under the Buy Indian Act. The form requires offerors to represent whether they meet the definition of an "Indian Economic Enterprise" with Indian ownership, specifically mandating that: (1) at least 51% ownership is by Indians/Tribal Entities, (2) at least 51% of contract earnings are received by Indians/Tribal Entities, and (3) management and daily business operations are controlled by one or more individuals who are Indians.
The form is associated with a Sources Sought Notice for prescription eyeglasses for Billings Area Indian Health Service locations, with a North American Industry Classification System (NAICS) code of 339115 for Ophthalmic Goods Manufacturing. The potential contract duration is one base year with four optional years. Interested Indian Small Business Economic Enterprises (ISBEEs) must submit detailed capability statements demonstrating their experience in providing prescription eyeglasses, ownership structure, earnings distribution, and management control by Indians. Responses should be emailed to mitzi.horn@ihs.gov, and successful offerors must also be registered in the System of Award Management (SAM).
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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: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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