BIRepForm.pdf

DEPARTMENT OF HEALTH & HUMAN SERVICES

Division of Acquisilion Policy (DAP) 5600 Fishers Lane

Rockville, t\4D 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN FIR]VI REPRESENTATION FORJU

SoLICIATION NUMBER: cRHc-1s-12

PROJECT TITLE:

DATE:

BPA Medical/Lab Suoolies

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 "lndian Firm" (HHSAR 326.602) with "lndian Ownership" (HHSAR 326.603), in response to this solicitation and resultant contract.

The enterprise must meet the definition of"lndian Firm" throughout the following time periods:

( I ) At the time an offer is made in response to this solicitation;

(2) At the time of contract award; and

(3) Duringthefull term ofthe contract pedormance period. At any point during these periods, ifthe 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 lndian Act and awards may be subject to protest ifthe eligibility of the successful Offeror is in question. ln addition to the self-certification requirements, successful Offerors must also be registered with DUN and

Bradstreet (D&B) and the System of Award Management (SAM).

Any false or rnisleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy lndian Act is a violation of the law and punishable under I 8 U.S.C. l00l .

False claims submitted as part of contract performance are subject to the penalties enumerated in 3 I U.S.C. 3729 to

373 | and l8 U.S.C. 287.

REPRESENTATION

The Offeror represents as part of its offer that it does does not with "lndian Ownership" under the authority of the Buy Indian Act

Business Name meet the definition ofan "lndian Firm"

Certi!ing Signature

DIJNS Number Print Name