IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Counseling Services _ Licensed Therapists Federal contract opportunity
- Solicitation number
- IHS1489501
About this file
This document is an Indian Health Service (IHS) solicitation for a Buy Indian Act set-aside for non-personal service contract for Therapists (Child/Adult) healthcare providers to support the Counseling Services Department at the Chinle Comprehensive Health Care Facility (CCHCF) in Chinle, Arizona.
The solicitation describes a 12-month labor hour type contract with three 3-month option periods. Services shall be performed in accordance with the attached Performance Work Statement. IHS is seeking proposals from Indian Economic Enterprises (IEEs) that meet the definition under the Buy Indian Act. Offerors must provide complete candidate profiles, relevant experience, past performance, and pricing. The Government will evaluate proposals based on best value considering factors such as past performance, experience, qualifications, and competitive pricing. Offers are due directly to the Contracting Officer. The selected contractor's personnel will be subject to pre-security/fingerprint clearance prior to start of work.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 52.212-3 Offeror Representations and Certifications—Commercial Products and Commercial Services (Sep 2023).pdf | ||
| Pricing Schedule_Open Market_Therapists.pdf | ||
| 3 - PWS Licensed Child or Adult Therapist.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
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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