Buy Indian Act Form.pdf

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Optical Coherence Tomographer (OCT with Angiography
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RFQ24626Q0029
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This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form required for federal contract solicitations set-aside under the Buy Indian Act authority.

Offerors responding to Indian Health Service Sources Sought Notices, Requests for Information (RFI), or Solicitations must complete this self-certification form to represent that they meet the definition of an "Indian Economic Enterprise" with Indian Ownership as defined in EEHSAR 326.601. The enterprise must maintain eligibility status at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. Any change in eligibility status during these periods requires immediate written notification to the Contracting Officer. The form requires identification of the Federally Recognized Tribal Entity and the 51% owner of the Indian Economic Enterprise Firm, along with business name and Unique Entity Identifier (UEI) number. Successful offerors must also be registered with the System of Award Management (SAM). The form includes warnings that false or misleading information 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 require documentation of eligibility before award, and contracts are subject to protest if offeror eligibility is questioned.

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Text version

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Servic

Division of Acquisition Policy 5600 Fishers Lane

Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

IN

REPRESENTATION FORM

SOLICI ATION : _________________________________________________

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 ” (HHSAR 326.60 ) in response to this olicitation and resultant contract.

The enterprise must meet the definition of “Indian ” 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 ” with “Indian Ownership” under the authority of the Buy Indian Act.

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