IHS IEE Representation Form_IHS1503991.pdf
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- Attached to
- Sources Sought for Load Bank Testing of Emergency Power Supply Systems and Fuel Quality Testing
- Solicitation number
- IHS1503991
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form for a Sources Sought notice related to a federal contract opportunity.
The Sources Sought notice is for annual fuel quality testing and annual load bank testing of Emergency Power Supply Systems (EPSS) located at facilities throughout the Indian Health Service (IHS) Great Plains Area. The contractor must be capable of performing fuel quality testing, load bank testing, generator startup, load transfer, and post-test procedures on equipment from various manufacturers. The applicable NAICS code is 541380 with a $19 million small business size standard.
The IHS is seeking responses from Indian Small Business Economic Enterprises (ISBEEs) and Indian Economic Enterprises (IEEs) that can meet the stated requirements. Interested parties must submit a capability statement, SAM registration details, and complete the IEE Representation Form to self-certify their eligibility. The IHS will use the responses to determine if the requirement can be set aside for IEE/ISBEE or if it must be competed as a full and open procurement.
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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: 11/01/2024 |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: IHS1503991 |
| PROJECT_TITLE: Load Bank Testing of Emergency Power Supply Systems and Fuel Quality Testing |
| DoesNot: 0 |
| Does: Off |
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