IHS IEE Form.pdf
PDF 131 KB Posted
- Attached to
- On-Call Lawn Care Services
- Solicitation number
- IHS-SS-26-1527661
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form template used for the Indian Health Service (IHS) to verify offeror eligibility for contract set-asides and sole-source awards. The form is issued by the Department of Health & Human Services, Office of Management Services, Division of Acquisition Policy.
Offerors responding to IHS solicitations, sources sought notices, or requests for information must self-certify their status as an "Indian Economic Enterprise" with Indian ownership as defined in HHSAR 326.601 under the authority of 25 U.S.C. 47. Enterprises must maintain eligibility at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. Offerors must immediately notify the Contracting Officer in writing if they no longer meet eligibility requirements at any point during performance. The form requires identification of the federally recognized tribal entity, the 51% owner of the Indian Economic Enterprise firm, business name, and DUNS number. Successful offerors must register with the System of Award Management (SAM) in addition to completing this self-certification. False or misleading information constitutes a violation subject to penalties under 18 U.S.C. 1001, while false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. The form includes space for the certifying signature and printed name of an authorized representative.
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| File | Type | Posted |
|---|---|---|
| Sources Sought Notice.pdf | ||
| PWS_DFM Lawn Care.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: IHS1527661 |
| PROJECT_TITLE: Lawn Care Services |
| DoesNot: 0 |
| Does: Off |
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