IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 135 KB Posted
- Attached to
- Water Service Line Okmulgee, OK
- Solicitation number
- RFQ1514595
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for a water service line project in Okmulgee, OK. The solicitation (RFQ1514595) is a 100% Indian-owned set-aside under NAICS code 237110, with a size standard of $45.0 million. The project requires furnishing and installing a water service line with a 60-calendar day performance period from Notice to Proceed.
Key details include a quote submission deadline of July 10, 2025, at 5:00 p.m. CST, with quotes to be received via email or sealed envelope. The estimated award amount is under $25,000, and quotes will be evaluated on an acceptable/non-acceptable basis, first ranked by price and then assessed for technical acceptability. Offerors must submit a firm, fixed-price quote on SF18, technical specifications, materials list, two relevant past performance references, and the IEE Representation Form. The solicitation is issued by the Department of Health and Human Services Indian Health Service.
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Other files
| File | Type | Posted |
|---|---|---|
| 6817 SOW WSL HDPE - Esigned.pdf | ||
| 6817 OEH8 Proposed Signed DLB.pdf | ||
| SF18-95a Request for Quote.docx | DOCX document | |
| Construction Clauses-DEVIATION FEB 2025.docx | DOCX document | |
| 6817 Bid Sheet WSL.xlsx | XLSX spreadsheet | |
| ok30 (1).txt | TXT text file |
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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: RFQ1514595 |
| PROJECT_TITLE: Water Service Line Okmulgee, OK |
| DoesNot: 0 |
| Does: Off |
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