B11 - IEE Representation.pdf
PDF 130 KB Posted
- Attached to
- BFSU LED Slit Lamp with Tonometer
- Solicitation number
- BFSU-25-070
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form issued by the Indian Health Service (IHS) for a solicitation related to a LED Slit Lamp with Tonometer procurement at the Blackfeet Service Unit in Browning, Montana. The solicitation (Number BFSU-25-070) is set aside initially for Indian Small Business Economic Enterprises (ISBEE) under the Buy Indian Act, with a cascading set-aside hierarchy if insufficient ISBEE offers are received: first to Service Disabled Veteran Owned Small Businesses, then Certified HubZone Small Businesses, and finally Small Disadvantaged Businesses.
The procurement involves purchasing two Haag-Streit BP900 LED Slit Lamps and two corresponding Haag-Streit Tonometers, with a firm fixed price purchase order anticipated. Key dates include a quote submission deadline of August 11, 2025 at 5pm MT, with quotes to be submitted electronically. The solicitation requires offerors to submit three volumes: technical, past performance, and price, with evaluation criteria focusing on management/understanding of the Statement of Work, past performance relevance/quality, and price reasonableness. Offerors must be registered in the System of Award Management (SAM) and complete an Indian Economic Enterprise Representation Form demonstrating at least 51% Indian ownership and control.
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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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