IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Purchase of Laptops and Workstations Lifecycle Refresh Federal contract opportunity
- Solicitation number
- 75H70826Q00001
About this file
This is a self-certification representation form issued by the Indian Health Service (IHS), Office of Management Services, Division of Acquisition Policy, for the Buy Indian Act Indian Economic Enterprise program.
The form requires offerors to self-certify their eligibility as an "Indian Economic Enterprise" (IEE) with Indian ownership in accordance with 25 U.S.C. 47 and HHSAR 326.601. Eligibility must be maintained at three critical junctures: at the time an offer is submitted, at the time of contract award, and throughout the full performance period of any resulting contract. Contractors must immediately notify the Contracting Officer in writing if they cease to meet eligibility requirements at any point. The form applies to Sources Sought Notices, Requests for Information (RFI), and formal Solicitations. Offerors must indicate whether they meet or do not meet the IEE definition and provide the name of the federally recognized tribal entity, the 51% owner of the IEE firm, the business name, UEI SAM number, and a certifying signature with printed name. Successful offerors must also register with the System of Award Management (SAM). Submission of false or misleading information constitutes a violation under 18 U.S.C. 1001, while false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Individual Contracting Officers may require documentation of eligibility before awarding set-aside or sole source contracts, and awards are subject to protest if the offeror's eligibility is questioned.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| RFQ No. 75H70826Q00001 Amendment No. 00002_Question & Answer.pdf | ||
| RFQ No. 75H70826Q00001 Amendment No. 00001_To Extend the Due Date.pdf | ||
| VPAT2.5Rev_508_February2025.pdf | ||
| Buy Indian Act.pdf | ||
| RFQ No. 75H70826Q00001 for Laptop & Workstations Lifecycle Refresh.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
UEI SAM Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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