IHS IEE Representation Form__508 Compliant_ BLANK.docx
DOCX document 45 KB Posted
- Solicitation number
- RFQIHS1528549
About this file
This is a blank Indian Economic Enterprise (IEE) Representation Form required for the Buy Indian Act set-aside solicitation RFQIHS1528549 issued by the Department of Health and Human Services Indian Health Service. The form serves as a self-certification document that offerors must complete to demonstrate they meet the definition of an "Indian Economic Enterprise" as defined under 25 U.S.C. 47 and HHSAR 326.601. Offerors must certify their eligibility at three critical points: at the time of offer submission, at the time of contract award, and throughout the full contract performance period. Any contractor that loses eligibility during these periods must provide immediate written notification to the Contracting Officer.
The form requires offerors to provide their firm's business name, DUNS number, the name of the federally recognized tribal entity, the name of the 51% owner of the IEE firm, and a certifying signature from an authorized representative. The document emphasizes that false or misleading information submitted in connection with a Buy Indian Act set-aside is a violation of federal law under 18 U.S.C. 1001, and false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Additionally, successful offerors must be registered in the System of Award Management (SAM). Individual Contracting Officers may require supporting documentation of eligibility before awarding set-aside or sole source contracts, and awards may be subject to protest if the successful offeror's eligibility is questioned.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SOW WSL HDPE - EsignAFB.pdf | ||
| RFQIHS1528549.pdf | ||
| OEH8 Proposed Signed AFB.pdf | ||
| WD OK20260033 05.18.26.pdf | ||
| WSL Bid Sheet IHS1528549.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .