IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 2 MB Posted
- Attached to
- Assorted Medical Supplies
- Solicitation number
- GRSSC-24-SS-0023
About this file
This document is an Indian Health Service (IHS) IEE Representation Form related to a federal contract opportunity. The form requires the offeror to self-certify that they meet the definition of an "Indian Economic Enterprise" (IEE) under the Buy Indian Act in order to be eligible for set-aside contracts. The offeror must represent that they meet the IEE definition at the time of offer, award, and throughout contract performance. The form collects information such as the name of the 51% owner, the name of the Federally Recognized Tribal Entity, and the offeror's DUNS number.
The related federal contract opportunity is a Sources Sought notice from the IHS Gallup Regional Supply Service Center for Assorted Medical Supplies under NAICS code 339113. The agency is seeking capable sources, with a preference for Indian Economic Enterprises under the Buy Indian Act. Interested offerors must submit capability information including size status, socioeconomic program participation, and recent relevant experience by May 20, 2024 for the agency to determine the appropriate acquisition strategy, such as an IEE set-aside.
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| File | Type | Posted |
|---|---|---|
| Draft Master Supply List Medical.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
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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