IHS IEE Representation Form__508 Compliant_ BLANK.docx
DOCX document 45 KB Posted
- Solicitation number
- RFQIHS1527373
About this file
This is a blank Indian Economic Enterprise Representation Form required by the Indian Health Service (IHS) under the Buy Indian Act authority. The form serves as a self-certification document for offerors to declare whether they meet the definition of an "Indian Economic Enterprise" (IEE) with Indian ownership as defined in HHSAR 326.601. Offerors must certify their eligibility status at three critical junctures: at the time an offer is submitted, at contract award, and throughout the entire contract performance period. The form requires the offeror to provide the name of the federally recognized tribal entity, the name of the 51% owner of the IEE firm, the business name, certifying signature, and DUNS number.
Any contractor that no longer meets IEE eligibility requirements at any point during the solicitation, award, or performance phases must provide immediate written notification to the Contracting Officer. The IHS Division of Acquisition Policy reserves the right to request documentation supporting eligibility claims before awarding set-aside or sole source contracts, and awards may be subject to protest if the successful offeror's eligibility is questioned. False or misleading information submitted during the offer process constitutes a violation of 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. Successful offerors must also maintain current registration in the System of Award Management (SAM).
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Other files
| File | Type | Posted |
|---|---|---|
| RFQIHS1527373 SB II.pdf | ||
| RFQIHS1527373 SB II.pdf | ||
| RFQIHS1527373 SB.pdf | ||
| OEH-8.pdf | ||
| WD OK20260030 05.18.26.pdf | ||
| SOW Signed.pdf | ||
| SF18-95a Request for Quote RFQIHS1527343.pdf | ||
| CONTRACT CLAUSES.pdf | ||
| FBO Announcement RFQIHS1527343.pdf | ||
| Bid Sheet.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
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