IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 217 KB Posted
- Attached to
- Solid Waste Collection for Ft. Thompson IHS, Ft. Thompson, SD Federal contract opportunity
- Solicitation number
- IHS1508670
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for a Solid Waste Collection project at Fort Thompson IHS in Fort Thompson, South Dakota. The solicitation number is IHS1508670, and the form requires self-certification by an offeror that they meet the definition of an "Indian Economic Enterprise" with Indian ownership under the Buy Indian Act.
The form outlines specific requirements for an Indian Economic Enterprise, including maintaining eligibility: (1) at the time of offer, (2) at contract award, and (3) throughout the entire contract performance period. Offerors must be registered in the System of Award Management (SAM) and understand that providing false information is punishable under federal law. The form provides space for the business to indicate whether they meet the IEE definition, with fields for the 51% owner's name, a certifying signature, the federally recognized tribal entity, business name, and UEI number.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sources Sought Notice IHS1508670.pdf | ||
| SOW Solid Waste Collection.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
UEI Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: IHS1508670 |
| PROJECT_TITLE: Solid Waste Collection Fort Thompson IHS, Fort Thompson, SD |
| DoesNot: 0 |
| Does: Off |
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