IEE Representation Form.pdf
PDF 218 KB Posted
- Solicitation number
- SS-24-PHX-058
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form for a federal contract opportunity related to the procurement of Omnicell Cabinets at the Fort Yuma Health Care Clinic.
The key details are as follows:
The solicitation is being issued by the Indian Health Service, a civilian agency under the Department of Health and Human Services. The procurement is seeking a contractor to provide, install, and provide end-user training for Omnicell Cabinets at the Fort Yuma Health Care Clinic, including the removal and disposal of old equipment. The contract will be set aside for IEE firms that meet the definition under the Buy Indian Act. Interested firms must submit an IEE Representation Form, along with a Capability Statement demonstrating alignment with the requirement. Responses are requested to be sent to the contracting officer, Jeremiah Murrell. No specific response deadline or award date is provided in the documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| SS-24-PHX-058.pdf | ||
| Technical Specifications_FY24_Yuma Omnicell XT.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
Unique Entity Identifier (UEI) Number
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
| Date1_af_date: |
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