IHS IEE Representation Form_Jan 2022_508 Compliant 04.24.pdf
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- Attached to
- IHS1496209 Sources Sought GIMC Medical Waste Federal contract opportunity
- Solicitation number
- IHS1496209
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form for a federal contract opportunity. The Indian Health Service (IHS) is seeking sources to provide infectious waste pickup services for the Tohatchi Health Center in New Mexico. The anticipated period of performance is a base year from 9/1/2024 to 8/31/2025 with two one-year option periods.
The applicable NAICS code is 562211 - Hazardous Waste Treatment and Disposal. In accordance with the Buy Indian Act, IHS will give preference to Indian economic enterprises. Interested parties must submit a capabilities package that includes confirmation of Buy Indian set-aside eligibility, firm size and socioeconomic status, recent relevant experience, and a statement of intent to submit a quote. Submissions are due by 7/15/2024. The government will use the responses to determine the appropriate acquisition strategy, which may include an IEE set-aside.
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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
Unique Entity ID (UEI)
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