IHS IEE Representation Form.pdf
PDF 130 KB Posted
- Attached to
- Non-PSC Family Medicine Physician Assistant/Nurse Practitioner for Northern Navajo Medical Center
- Solicitation number
- IHS1481830
About this file
This document provides details for a federal contract opportunity with the Indian Health Service seeking a non-personal services contract for one Physician Assistant/Nurse Practitioner for the Family Medicine Department at the Northern Navajo Medical Center in Shiprock, New Mexico. The period of performance will be for twelve continuous months starting from the date of award, which is anticipated to be January 10, 2022 through January 9, 2023. The acquisition is set aside for Indian-owned small businesses. Evaluation factors may include technical capability to meet the government need, minimum education requirements, professional certifications, past performance, and price. Quotes are due no later than March 11, 2024 and shall be submitted via email with an attached pricing schedule. Questions regarding this solicitation must be submitted no later than five days before the closing date.
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Other files
| File | Type | Posted |
|---|---|---|
| Terms and Condition Solicitation 1481830.pdf | ||
| 3. Performance Work Statement (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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