IEE Representation Form.pdf
PDF 133 KB Posted
- Attached to
- GIMC Fire Suppression System Investigation
- Solicitation number
- IHS1526873
- Issued by
- Not on record
About this file
This is a self-certification representation form for Indian Economic Enterprises (IEE) in response to Indian Health Service (IHS) solicitations issued under the Buy Indian Act authority (25 U.S.C. 47). The form serves as a template for the Office of Management Services, Division of Acquisition Policy (DAP) and requires offerors to certify their eligibility as an Indian Economic Enterprise with Indian Ownership. The certification must be accurate at three critical junctures: when the offer is submitted, at the time of contract award, and throughout the full contract performance period. Contractors must immediately notify the Contracting Officer if eligibility status changes at any point during these periods.
The form requires completion of specific fields including the solicitation/sources sought/RFI number, project title, date, the name of the federally recognized tribal entity, business name, Unique Entity Identifier (UEI) number, the name of the 51% owner of the IEE firm, certifying signature, and printed name of the signatory. Successful offerors must also maintain registration with the System of Award Management (SAM). The document emphasizes that false or misleading information in offers for Buy Indian Act set-aside or sole-source contracts violates 18 U.S.C. 1001 and subjects the enterprise to criminal penalties, while false claims during contract performance are subject to civil penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Individual Contracting Officers retain the authority to request supporting documentation of eligibility, and awards may be protested if the successful offeror's eligibility is questioned.
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| File | Type | Posted |
|---|---|---|
| Sources Sought - GIMC Fire Suppression.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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