Buy Indian Act Form.pdf

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Attached to
Portable Electrocardiogram (ECG) Machine
Solicitation number
IHS1530045
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About this file

This document is an Indian Economic Enterprise Representation Form required by the Indian Health Service (IHS) under the Buy Indian Act authority.

The form serves as a self-certification document that offerors must complete to demonstrate eligibility as an "Indian Economic Enterprise" with "Indian Ownership" in accordance with 25 U.S.C. 47 and EEHSAR 326.601. The form applies to Sources Sought Notices, Requests for Information (RFI), and Solicitations issued by IHS. Offerors must certify their eligibility at three critical junctures: when submitting an offer, at the time of contract award, and throughout the entire contract performance period. Contractors must immediately notify the Contracting Officer in writing if they cease to meet eligibility requirements at any point during these periods. The form requires offerors to identify the Federally Recognized Tribal Entity, the 51% owner of the Indian Economic Enterprise (IEE) Firm, business name, UEI Number, and include a certifying signature with printed name. Contracting Officers may request documentation of eligibility before awarding set-aside or sole source contracts, and awards are subject to protest if offeror eligibility is questionable. Offerors must also register with the System of Award Management (SAM). The form warns that false or misleading information submitted in response to Buy Indian Act set-asides violates 18 U.S.C. 1001, while false claims during contract performance are subject to penalties under 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.

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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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