IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 129 KB Posted
- Attached to
- Solicitation 75H70726Q00061-Pest Control Services for Zuni Comprehensive Community Health Center (ZCCHC)
- Solicitation number
- Solicitation_75H70726Q00061
About this file
This is a representation form required by the Indian Health Service (IHS) for the Buy Indian Act, used to certify Indian Economic Enterprise (IEE) eligibility in response to sources sought notices, requests for information (RFI), or solicitations.
The form constitutes self-certification that an offeror meets the definition of an "Indian Economic Enterprise" as defined in HHSAR 326.601. Enterprises must maintain eligibility at three critical points: when submitting an offer, at the time of contract award, and throughout the full contract performance period. Contractors must immediately notify the Contracting Officer in writing if they cease to meet eligibility requirements at any point. Contracting Officers may require documentation of eligibility before awarding set-aside or sole source contracts under the Buy Indian Act, and awards are subject to protest if the successful offeror's eligibility is questioned. Successful offerors must also register with the System of Award Management (SAM). The form requires the offeror to represent whether it meets the definition of an Indian Economic Enterprise with Indian Ownership, and must be signed by an authorized representative. Required information includes the name of the federally recognized tribal entity, the 51% owner of the IEE firm, business name, DUNS number, and certifying signature with printed name. Submission of false or misleading information is punishable under 18 U.S.C. 1001, and false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
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Other files
| File | Type | Posted |
|---|---|---|
| Pricing table_.docx | DOCX document | |
| Sol_75H70726Q00061 terms and conditions.pdf | ||
| QA_.docx | DOCX document | |
| Past Performance Survey_Sol 75H70726Q00061.docx | DOCX document |
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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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