IEE Representation Form.pdf
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- Solicitation number
- SS-26-PHX-024
About this file
This is a self-certification form for Indian Economic Enterprise (IEE) representation under the Buy Indian Act, issued by the Indian Health Service (IHS), Office of Management Services, Division of Acquisition Policy.
The form serves as a template for offerors to certify their eligibility as an Indian Economic Enterprise with Indian Ownership in response to IHS Sources Sought Notices, Requests for Information (RFI), or Solicitations. Offerors must complete the representation section by checking whether they do or do not meet the definition of an Indian Economic Enterprise under 25 U.S.C. 47 and HHSAR 326.601. The certification requires submission of the Federally Recognized Tribal Entity name, the 51% owner's name, business name, Unique Entity Identifier (UEI) number, and a certifying signature with printed name. Offerors must meet the eligibility definition at three critical junctures: when submitting the offer, at contract award, and throughout the full contract performance period. Any changes in eligibility status require immediate written notification to the Contracting Officer. The form carries significant legal weight, as false or misleading information constitutes a violation of 18 U.S.C. 1001 and may subject the offeror to penalties under 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287. Successful offerors must also be registered with the System of Award Management (SAM), and awards may be subject to protest if eligibility is questioned.
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Other files
| File | Type | Posted |
|---|---|---|
| SS-26-PHX-024 UPS PM.docx | DOCX document | |
| PWS UPS.docx | DOCX document |
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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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