IHS IEE Form.pdf
PDF 132 KB Posted
- Attached to
- PHARMACIST
- Solicitation number
- IHS1505114
About this file
This is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form designed for businesses seeking to self-certify as an Indian Economic Enterprise for federal contract opportunities. The form requires offerors to represent whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act, and mandates that the enterprise must maintain this status at the time of offer, contract award, and throughout the entire contract performance period.
The form is specifically associated with a pre-solicitation Sources Sought Notice (Solicitation Number IHS1505114) for Pharmacist Services at the IHS Hospital in Fort Yates, North Dakota. The anticipated contract will be a Firm Fixed-Price, Non-Personal Health Care Service contract with a performance period from 8/1/2025 through 12/31/2026. Interested parties are required to submit a capability statement by May 1, 2025, at 1:00 p.m. Central Time, with responses to be emailed to the Point of Contact, Denese Carty, using the NAICS code 561320 (Temporary Help Services). The solicitation emphasizes that this is a market research effort to determine the availability of Indian Small Businesses Economic Enterprise (ISBEE) or Indian Economic Enterprises (IEE) for providing onsite pharmacist services.
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Other files
| File | Type | Posted |
|---|---|---|
| SOW Pharmacist _IDIQ 2024.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
UEI Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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