IEE Representation.pdf
PDF 130 KB Posted
- Solicitation number
- 75H709-BAIHS-25-010
About this file
The document is an Indian Economic Enterprise (IEE) Representation Form from the Department of Health and Human Services Indian Health Service, designed for use in the Buy Indian Act procurement process. The form requires offerors to self-certify whether they meet the definition of an "Indian Economic Enterprise" with Indian ownership, with specific requirements that the enterprise must maintain this status at the time of offer, contract award, and throughout the contract performance period. The form emphasizes that providing false or misleading information is a violation of law punishable under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731, and mandates that successful offerors must be registered in the System of Award Management (SAM).
The form is specifically related to a Sources Sought Notice (Solicitation Number 75H709-BAIHS-25-010) for Pharmacy Claims Switching and Benefit Eligibility Verification Services for the Billings Area Indian Health Service locations. The anticipated NAICS code is 518210 (Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services), with a potential twelve-month base period and four option periods. The procurement aims to serve six Health Service Units providing healthcare to over 70,000 American Indian and Alaska Native people in Montana, requiring electronic pharmaceutical claims switching and web-based pharmacy benefit eligibility verification services.
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Other files
| File | Type | Posted |
|---|---|---|
| Pharmacy Claims Switching Draft SOW.pdf |
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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 SAM Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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