IHS IEE Representation Form.pdf
PDF 138 KB Posted
- Solicitation number
- IHS1493796
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form for a federal contract opportunity. It is used to self-certify that the offeror meets the definition of an "Indian Economic Enterprise" under the Buy Indian Act for the purposes of responding to the solicitation, being awarded the contract, and performing the contract.
The related federal contract opportunity is a solicitation for a non-personal services contract for one Pediatric Outpatient Clinic Registered Nurse to provide services at the Northern Navajo Medical Center in Shiprock, New Mexico. The contract will have a base period and an option period, with an estimated period of performance from August 7, 2024 to February 7, 2025. The solicitation is a set-aside for Buy Indian small businesses under the Buy Indian Act. Evaluation criteria include past performance, qualifications, and price, with past performance and qualifications being significantly more important than price. Offerors must submit a completed IHS IEE Representation Form, resume and certifications for the proposed candidate, pricing schedule, proof of comparable experience, and evidence of past performance in providing qualified candidates.
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Office of Management Services Division of Acquisition Policy (DAP)
5600 Fishers Lane Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
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 the 51% owner of IEE Firm
Certifying Signature
Print Name
Name of Federally Recognized Tribal Entity
Business Name
UEI Number
| DATE: 6/27/2024 |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: IHS1486746 |
| PROJECT_TITLE: Preventive Maintenance for Optometry Equipment |
| DoesNot: 0 |
| Does: Yes |
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