IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 129 KB Posted
- Solicitation number
- 75H70726Q00077
About this file
This document is a self-certification form required by the Indian Health Service (IHS) for vendors responding to federal contract opportunities under the Buy Indian Act.
The form serves as a representation that an offeror meets the definition of an "Indian Economic Enterprise" (IEE) as defined in HHSAR 326.601. Offerors must certify their eligibility at three critical junctures: when submitting an offer, at the time of contract award, and throughout the entire contract performance period. The enterprise must maintain its IEE status continuously during these periods, and any loss of eligibility requires immediate written notification to the Contracting Officer. The form applies to Sources Sought Notices, Requests for Information (RFI), and formal Solicitations. Successful offerors must also be registered in the System of Award Management (SAM). The form requires completion of standard fields including the solicitation number, project title, date, the name of the Federally Recognized Tribal Entity, the 51% owner of the IEE firm, business name, and DUNS number. The signature of an authorized representative certifies the enterprise's eligibility status. False or misleading information submitted in offers is subject to penalties under 18 U.S.C. 1001, while false claims during contract performance are subject to penalties enumerated in 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4_Q_and_A_Responses_Amendment_0001.pdf | ||
| Sol_75H70726Q00077_Amendment_0001.pdf | ||
| 2_Revised_Fillable Pricing Table_Amendment_0001.docx | DOCX document | |
| Attachment 1_Past Performance Survey.docx | DOCX document | |
| SOL_75H70726Q00077 - MSU.pdf | ||
| Attachment 2_Fillable Pricing Table.docx | DOCX document | |
| Attachment 4_Q and A Template.xlsx | XLSX spreadsheet |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
File details come from the government source that posted it. Updated .