IHS IEE Representation Form_Jan 2022_508 Compliant.pdf

PDF 129 KB Posted

Attached to
Water Service Line Boynton, OK Federal contract opportunity
Solicitation number
246-24-Q-0199
Issued by
Department of Health and Human Services Indian Health Service

About this file

This document is an Indian Economic Enterprise (IEE) Representation Form for a federal contract opportunity. It requires the offeror to self-certify that they meet the definition of an "Indian Economic Enterprise" under the Buy Indian Act, which must be maintained throughout the contract period. The form includes details on the relevant solicitation/sources sought/RFI number, project title, and the offeror's business information.

The related federal contract opportunity is a solicitation for furnishing and installing a Water Service Line in Boynton, OK. It is a 100% Indian-owned set-aside under NAICS code 237110, with a size standard of $45 million. The period of performance is 60 calendar days, with a site visit scheduled for August 16, 2024, and quotes due by August 30, 2024. The contract will be awarded to the responsible, responsive offeror with the lowest reasonable price who meets all technical specifications.

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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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