IHS IEE Representation Form__508 Compliant_ BLANK.docx
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- Solicitation number
- 75H71126Q00012
About this file
This is a certification form used by the Indian Health Service (IHS) to verify that an offeror qualifies as an "Indian Economic Enterprise" (IEE) under the Buy Indian Act (25 U.S.C. 47) when responding to federal solicitations, sources sought notices, or requests for information.
The form requires offerors to self-certify their IEE eligibility status and affirms that the enterprise meets the statutory definition under HHSAR 326.601 at three critical junctures: at the time of offer submission, at contract award, and throughout the full contract performance period. Offerors must provide their firm name, identify the federally recognized tribal entity and the 51% owner of the IEE, include their DUNS number, and obtain a certifying signature from an authorized representative. The form emphasizes that any false or misleading information constitutes a violation of 18 U.S.C. 1001 and subjects the offeror to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Additionally, successful offerors must maintain registration with the System of Award Management (SAM), and contracting officers may request supporting documentation to verify eligibility prior to award, with awards subject to protest if the offeror's qualification 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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