IEE Representation Form.pdf
PDF 184 KB Posted
- Attached to
- Radiology Mobile CT Scanner Federal contract opportunity
- Solicitation number
- 75H70925R00008
About this file
The document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form, which requires offerors to self-certify their status as an Indian Economic Enterprise when responding to solicitations under the Buy Indian Act. The form mandates that the enterprise must meet the IEE definition at three critical points: when submitting an offer, at contract award, and throughout the entire contract performance period.
The form emphasizes strict compliance requirements, including immediate written notification to the Contracting Officer if eligibility changes, potential documentation requests to verify status, and severe legal penalties for false or misleading information. Offerors must check whether they do or do not meet the IEE definition, provide details about the 51% owner, the federally recognized tribal entity, business name, and DUNS number. Additionally, successful offerors must be registered in the System of Award Management (SAM), with contract awards potentially subject to protest if the offeror's eligibility is questioned.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| AMEND 0002 75H70925R00008 Rev. SOW.pdf | ||
| Amend 0001 - RFI Responses.pdf | ||
| Attachment_A_VistA2025_Imaging_DICOM.pdf | ||
| RFP 75H70925R00008 Radiology Mobile CT Scanner.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
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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