B11 - IEE Representation.pdf
PDF 143 KB Posted
- Attached to
- FBSU IT DELL Equipment Upgrade
- Solicitation number
- 75H70926BAO-035-RFQ
About this file
This is an Indian Economic Enterprise Representation Form issued by the Indian Health Service (IHS), Department of Health & Human Services, for the solicitation titled "FBSU IT Dell Equipment Upgrade" (Solicitation Number 75H70926BAO-035-RFQ, dated 04/06/2026).
The form serves as a self-certification document for offerors responding to this Buy Indian Act solicitation. Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" (IEE) with Indian ownership as defined under 25 U.S.C. 47 and HHSAR 326.601. Eligibility must be maintained throughout three critical periods: at the time of offer submission, at contract award, and during the full contract performance period. Any change in eligibility status during these periods requires immediate written notification to the Contracting Officer. Successful offerors must register with the System of Award Management (SAM) in addition to completing this self-certification. The form includes fields for the federally recognized tribal entity name, business name, 51% owner name, UEI SAM number, certifying signature, and printed name. False or misleading information submitted with an offer constitutes a violation of 18 U.S.C. 1001, while false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Individual Contracting Officers may request documentation of eligibility, and awards may be subject to protest if the offeror's eligibility is questioned.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| B02 - Dell Pro Slim Plus Desktop.pdf | ||
| B01 - 75H70926BAO-035-RFQ.pdf | ||
| B02 - Dell 3000 Thin Client.pdf | ||
| B02 - Scope of Work.pdf | ||
| B01 - Price Schedule.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: 04/06/2026 |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: 75H70926BAO-035-RFQ |
| PROJECT_TITLE: FBSU IT Dell Equipment Upgrade |
| DoesNot: 0 |
| Does: Off |
File details come from the government source that posted it. Updated .