B11 - IEE Representation.pdf
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- Solicitation number
- SS75H70925NC007
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for a Sources Sought Notice related to Fire Alarm Inspection & Monitoring services. The form requires businesses to self-certify whether they meet the definition of an Indian Economic Enterprise, which includes requirements that: (1) at least 51% of the enterprise is owned by Indians or Indian Tribes, (2) Indians or Indian Tribes receive at least 51% of contract earnings, and (3) daily business operations are controlled by one or more Indians. The form emphasizes that false or misleading information is punishable under federal law, and that enterprises must maintain IEE status throughout solicitation, award, and contract performance periods.
The associated Sources Sought Notice (Solicitation Number SS75H70925NC007) seeks qualified Indian Economic Enterprises to provide fire alarm inspection and monitoring services for the Northern Cheyenne Service Unit in Lame Deer, Montana. The requirement involves quarterly, semi-annual, and annual inspections and 24-hour remote monitoring for one health clinic and one government housing quarter. Interested parties must submit a detailed capability statement demonstrating their experience, qualifications, and compliance with IEE requirements by email to Tanya.Azure@ihs.gov within 15 days of the announcement. The contract is classified under NAICS code 561210 with a size standard of $47.0 million and is anticipated to be a one-year base contract with four option years.
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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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