Buy Indian Compliant Form_IHS1513118.pdf
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- Attached to
- IHS1513118 Multi-Function Device (copier, fax, scan, email) Lease for the Pawnee Indian Health Center
- Solicitation number
- IHS1513118
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise Representation Form for Solicitation Number IHS1513118. The solicitation is for a Multi-Function Device (copier, fax, scan, email) Lease for the Pawnee Indian Health Center, classified as a pre-solicitation Sources Sought notice. The form requires potential Indian Economic Enterprises (IEEs) to self-certify their eligibility under the Buy Indian Act, confirming they meet the definition throughout the solicitation, contract award, and performance periods. Interested parties must submit a capability statement and the representation form by 2:00 PM CST on May 29, 2025, via email to Amber Chavez. Respondents must provide details including company name, socioeconomic status, SAM UEI number, contact information, and demonstrate capability to provide the specified multi-function device lease services.
The solicitation emphasizes preference for Indian Small Business Economic Enterprises (ISBEEs) and requires a maximum five-page submission. Respondents must be registered in the System of Award Management (SAM) and provide comprehensive information about their business. The document warns that false or misleading information is punishable by law, and the government reserves the right to use submitted information for any legally appropriate purpose. This Sources Sought notice does not guarantee a contract award and serves to identify potential qualified vendors for the multi-function device lease requirement.
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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 Number
| DATE: 05/21/2025 |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: IHS1513118 |
| PROJECT_TITLE: IHS1513118 Multi-Function Device (copier, fax, scan, email) Lease for the Pawnee Indian Health Center |
| DoesNot: 0 |
| Does: Off |
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