IHS IEE Representation Form.pdf
PDF 184 KB Posted
- Attached to
- CISCO NETWORK UPGRADE Federal contract opportunity
- Solicitation number
- 75H70525Q00004
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form for a federal contract opportunity. The form is for a solicitation issued by the Department of Health and Human Services Indian Health Service, with the solicitation number 75H70525Q00004 and the project title "CISCO NETWORK UPGRADE". The solicitation is a 100% IEE set-aside, requiring offerors to complete the IEE certification form and include it with their proposal. Proposals are due on 12/02/2024 at 1 pm CST. The form outlines the requirements for an offeror to qualify as an IEE, including having at least 51% Indian ownership, and maintaining that status throughout the contract performance period. The form includes fields for the offeror to provide information about their business, such as DUNS number, business name, and tribal entity. Submitting false or misleading information is subject to legal penalties.
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| File | Type | Posted |
|---|---|---|
| Copy of Bill of Materials for BAO CISCO router and switches REVISED.xlsx | XLSX spreadsheet | |
| Combined Synposis Solicitation 75H70525Q00004.docx | DOCX document |
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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 #: 75H70525Q00004
PROJECT TITLE: CISCO NETWORK UPGRADE
DATE: 11/05/2024
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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