IHS IEE Representation Form.pdf
PDF 174 KB Posted
- Attached to
- SOURCES SOUGHT: Nonpersonal Services - Psychiatrist Federal contract opportunity
- Solicitation number
- IHS1506541
About this file
This is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form that contractors must complete to certify their eligibility under the Buy Indian Act for set-aside contracts. The form requires contractors to self-certify that they meet the definition of an "Indian Economic Enterprise" with at least 51% Indian ownership throughout three key periods: when making an offer, at contract award, and during the full contract performance period.
The form is associated with a Sources Sought notice (IHS1506541) for psychiatrist healthcare provider services at the Chinle Comprehensive Health Care Facility in Arizona, with a performance period of July 2025 to June 2026. Responses are due by March 18, 2025 at 5:00 PM MST. The opportunity falls under NAICS code 561320 (Temporary Help Services) with a $34 million size standard. Respondents must submit capability statements demonstrating relevant experience, their Buy Indian status via this form, UEI number, and intention to bid as prime contractor. The contracting officer may require additional documentation of eligibility, and false certifications are subject to penalties under federal law.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| PSYCHIATRY PWS DRAFT.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 tinez Cross-Out
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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