IHS IEE Representation Form.pdf
PDF 130 KB Posted
- Solicitation number
- IHS1481864_2
About this file
This document contains a federal contract opportunity for procuring family medicine physicians. The Indian Health Service, Shiprock Service Unit, Northern Navajo Medical Center located in Shiprock, New Mexico is seeking capable vendors to provide one full-time family medicine physician for a period of twelve continuous months starting January 10, 2023 through January 9, 2024. The acquisition is set aside for Indian-owned small businesses. Interested parties must submit quotes by February 22, 2024 and pricing information is required. The North American Industry Classification System code is 621111 for offices of physicians excluding mental health specialists, with a small business size standard of $16M. Evaluation factors will include technical capability, education and certification requirements, past performance, and price. Questions are due no later than two days before the closing date and must reference the solicitation number and title. Vendors must maintain an active System for Award Management profile.
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Other files
| File | Type | Posted |
|---|---|---|
| Terms and Condition Solicitation.pdf | ||
| Pricing Schedule.xlsx | XLSX spreadsheet | |
| 3. PWS.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 Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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