IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 1 MB Posted
- Solicitation number
- DZHC-SS-25-022
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form used for self-certification of tribal business ownership. The form is specifically designed for companies seeking to qualify as an Indian Economic Enterprise when responding to IHS solicitations, with requirements that the enterprise must meet IEE definition at offer submission, contract award, and throughout contract performance.
The form accompanies a specific Sources Sought Notice (Solicitation Number DZHC-SS-25-022) for Professional Pest Control Services at the Four Corners Regional Health Center in Red Mesa, Arizona. The market research notice seeks qualified contractors to provide pest control services, targeting elimination of insects, bed bugs, rodents, reptiles, and bats. The solicitation uses NAICS code 325320 with a small business size standard of 1,150 employees. Interested parties must submit responses by 03/24/2025 to Michael Austin, including company profiles, capabilities, ownership details, and completed IEE Representation Form. Submissions are voluntary and used to determine the acquisition strategy, including potential competition and set-asides for Indian-owned businesses.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| DZHC-SS-25-022.pdf |
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 .