IHS IEE Representation Form__508 Compliant_ BLANK.docx
DOCX document 45 KB Posted
- Solicitation number
- 75H71126Q00007
About this file
This is a blank Indian Economic Enterprise (IEE) Representation Form required by the Indian Health Service (IHS) for the Buy Indian Act set-aside solicitation 75H71126Q00007. The form serves as a self-certification document that offerors must complete to demonstrate eligibility as an Indian Economic Enterprise, defined under 25 U.S.C. 47 and HHSAR 326.601.
Offerors must certify their IEE status at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. The form requires identification of the federally recognized tribal entity and the 51% owner of the IEE firm, along with the business name, certifying signature, DUNS number, and printed name of the authorized representative. Contractors must maintain continuous eligibility throughout the contract term and provide immediate written notification to the Contracting Officer if eligibility status changes. The form emphasizes that false or misleading information constitutes a violation of federal law subject to penalties under 18 U.S.C. 1001 for false statements and 31 U.S.C. 3729-3731 for false claims during contract performance. Successful offerors must also register with the System of Award Management (SAM), and awards may be subject to protest if the IEE eligibility of the successful offeror is questioned.
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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
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