IHS IEE Representation Form__508 Compliant_ BLANK.docx
DOCX document 45 KB Posted
- Attached to
- Water service line and Septic Tank Lagoon for D. Rupnicki SR#574 in Mayetta, KS (Jackson Co. )
- Solicitation number
- 75H71126Q00006
About this file
This is a Buy Indian Act Indian Economic Enterprise Representation Form, a self-certification document required for offerors responding to Indian Health Service (IHS) solicitations, sources sought notices, or requests for information.
The form establishes that offerors must meet the definition of an "Indian Economic Enterprise" (IEE) as defined under 25 U.S.C. 47 and HHSAR 326.601. Eligibility must be maintained at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. Offerors must declare whether they do or do not meet the IEE definition and provide supporting information including the name of the federally recognized tribal entity, the name of the 51% owner, firm business name, DUNS number, and a certifying signature. The form emphasizes that contractors must immediately notify the contracting officer if they lose eligibility during performance. Contractors are required to be registered in the System of Award Management (SAM). The form warns that false or misleading information constitutes a violation under 18 U.S.C. 1001, with false claims during contract performance subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. This template applies to the water service line and septic tank lagoon installation project for D. Rupnicki in Mayetta, Kansas, issued by the Department of Health and Human Services Indian Health Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_75H71126Q00006_Amd_0001.pdf | ||
| 75H71126Q00006 SB.pdf | ||
| 75H71126Q00006 SB.pdf | ||
| 75H71126Q00006.pdf |
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
INDIAN HEALTH SERVICE BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
Indian Health Service Office of Management Services Division of Acquisition Policy (DAP) 5600 Fishers Lane Rockville, MD 20857
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 Federally Recognized Tribal Entity Name of the 51% owner of IEE Firm
Business Name Certifying Signature
DUNS Number Print Name image1.png image2.png image3.png image4.png
File details come from the government source that posted it. Updated .