IHS IEE Representation Form.pdf
PDF 129 KB Posted
- Attached to
- Pharmacist Services Federal contract opportunity
- Solicitation number
- IHS1489127
About this file
This document is a solicitation for a federal contract opportunity from the Department of Health and Human Services Indian Health Service. It is a solicitation for a Non-Personal Service Contract for a Contractor to provide Pharmacist healthcare providers to the Pinon Health Center, Navajo Area Indian Health Service throughout the contract period of performance.
The contract will be a 12-month labor hour type contract, with three 3-month option periods. The work is set aside for Buy Indian Act Indian Economic Enterprises. Offers must include a completed IHS IEE Representation Form, pricing, candidate profiles, evidence of experience and past performance. The Government will evaluate offers based on best value considering factors such as past performance, experience, qualifications, and competitive pricing. The selected contractor's personnel must comply with security/fingerprinting clearance requirements prior to starting work.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Wage Determination 2015-5477.pdf | ||
| PWS Pharmacist 09-29-20.pdf | ||
| 52.212-3 Offeror Representations and Certifications—Commercial Products and Commercial Services (Feb 2024).pdf | ||
| Pricing Schedule_Pharmacist.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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