IHS1519106 SSN Form-Indian Firm Representation.pdf
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- Solicitation number
- IHS1519106
About this file
This is an Indian Firm Representation Form required by the Indian Health Service (IHS) for the Buy Indian Act set-aside solicitation IHS1519106 for a GE Imaging Service Maintenance Agreement.
Offerors must self-certify that they meet the definition of an "Indian Firm" with "Indian Ownership" as defined under 25 U.S.C. 47 and HHSAR 326.602-603. The enterprise must maintain this eligibility status at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. Any change in eligibility status during these periods requires immediate written notification to the Contracting Officer. Successful offerors must also be registered with Dun & Bradstreet (D&B) and the System of Award Management (SAM). The form requires the business name, SAM Unique Entity ID Number, certifying signature, and printed name of the authorized representative. False or misleading information submitted with the offer constitutes a violation under 18 U.S.C. 1001, while false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. The Contracting Officer may request documentation of eligibility before award, and awards are subject to protest if the successful offeror's eligibility is questioned.
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Other files
| File | Type | Posted |
|---|---|---|
| IHS1519106 SSN GE Imaging SMA.pdf | ||
| IHS1519106 SOW 02.12.2026.pdf |
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Division of Acquisition Policy (DAP) 5600 Fishers Lane
Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN FIRM REPRESENTATION FORM
SOLICIATION NUMBER: _________________________________________________
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 Firm” (HHSAR 326.602) with “Indian Ownership” (HHSAR 326.603), in response to this solicitation and resultant contract.
The enterprise must meet the definition of “Indian Firm” 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 DUN and Bradstreet (D&B) and 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 Firm” with “Indian Ownership” under the authority of the Buy Indian Act.
Certifying Signature
Business Name
SAM Unique Entity ID Number Print Name wkohl Cross-Out
| SOLICITATION NUMBER: IHS1519106 SOURES SOUGHT NOTICE |
| PROJECT TITLE: GE IMAGING SERVICE MAINTENANCE AGREEMENT |
| DATE: |
| Business Name: |
| DUNS Number: |
| Print Name: |
File details come from the government source that posted it. Updated .