BIA Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Cisco Wireless Access Points for Gallup Regional Supply Service Center Federal contract opportunity
- Solicitation number
- IHS1494857
About this file
This document is a self-certification form for the Indian Economic Enterprise (IEE) Representation under the authority of the Buy Indian Act. The form requires the offeror to certify that their enterprise meets the definition of an "Indian Economic Enterprise" when submitting an offer in response to a solicitation or sources sought notice. Successful offerors must also be registered in the System for Award Management (SAM) database. False or misleading information submitted is punishable under federal law.
The related federal contract opportunity is for the procurement of Cisco wireless access points and related equipment for the Gallup Regional Supply Service Center. This is a 100% Native Owned Small Business Set-Aside solicitation with an NAICS code of 334111. The solicitation includes 8 line items for various Cisco networking products. Quotes are due by 05/21/2024 at 4:00pm CDT and will be evaluated on a Lowest Price Technically Acceptable basis. The period of performance is 45 days after award of a firm-fixed price purchase order.
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| File | Type | Posted |
|---|---|---|
| Amendment 1 - Offer Due Date.docx | DOCX document | |
| Specifications Cisco switch catalyst 9800 ect GRSSC signed.pdf | ||
| Combined Synopsis.Solicitation.docx | DOCX document |
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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
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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