IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 129 KB Posted
- Solicitation number
- 75H70724Q00088
About this file
This document is an Indian Economic Enterprise (IEE) Representation Form related to a federal contract opportunity. The form outlines the requirements for an enterprise to self-certify as an "Indian Economic Enterprise" under the Buy Indian Act in order to be eligible for a set-aside or sole-source contract. Key details include:
The solicitation number is 75H70724Q00088 for an Annual Service Agreement for the current Exterior and Interior Video Surveillance Security System at the Santa Fe Indian Health Center in New Mexico. The North American Industry Classification System (NAICS) code is 561621 with a $25 million business size standard. The procurement is set-aside for Indian Small Business Economic Enterprises that are also small business concerns. If enough competition or reasonable pricing is not received from this set-aside, the requirement may be opened to other small businesses. One single award will result from this solicitation. The period of performance is a base period with two option periods, based on satisfactory performance. Offerors must be registered in the System for Award Management (SAM) and have an active Unique Entity Identifier (UEI) number. Quotes are due by June 28, 2024 and must include a completed pricing table, past performance, signed SF-1449 form, and the signed IEE Representation Form.
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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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