IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Solicitation number
- 75H71324Q00080
About this file
This document is an Indian Health Service (IHS) IEE Representation Form. It is a self-certification form that an offeror must complete to verify it meets the definition of an "Indian Economic Enterprise" under the Buy Indian Act in order to be eligible for a set-aside or sole source contract. The form requires the offeror to provide information about the 51% owner, the name of the Federally Recognized Tribal Entity, the business name, and DUNS number. It states that any false or misleading information provided is subject to legal penalties.
The document also includes details on a related federal contract opportunity for the procurement of Dental X-Ray Sensors for the Fort Hall Service Unit. This is a firm fixed-price commercial item contract to be awarded as a Native Owned Small Business Set-Aside with a NAICS code of 339114. The required delivery date is December 31, 2024. Quotes are due by August 19, 2024 and will be evaluated on price and warranty. The contract will be awarded to the responsible offeror whose quote provides the best value to the government.
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Other files
| File | Type | Posted |
|---|---|---|
| 75H71324Q00080 SF-1449.pdf | ||
| 75H71324Q00080 Solicitation Clauses and Provisions.pdf | ||
| Schedule of Item.pdf |
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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
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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