IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 129 KB Posted
- Attached to
- Sewer Service, Henryetta, OK Federal contract opportunity
- Solicitation number
- 246-25-Q-0043
About this file
The document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form, designed to certify a business's eligibility for set-aside contracts under the Buy Indian Act. The form requires an offeror to self-certify that they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" at three critical stages: when making an offer, at contract award, and throughout the contract performance period. Businesses must be owned at least 51% by members of a federally recognized tribal entity and must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
The form includes important legal warnings about false representations, emphasizing that submitting misleading information is a violation punishable under federal law. Successful offerors must also be registered in the System of Award Management (SAM). The form provides space for key details including the name of the 51% owner, certifying signature, business name, DUNS number, and the name of the associated federally recognized tribal entity. Individual Contracting Officers retain the right to request documentation verifying the enterprise's eligibility before awarding set-aside or sole source contracts under the Buy Indian Act.
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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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