Indian Firm Representation Form-1522549.pdf
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- Solicitation number
- IHS-SS-26-1522549
About this file
This is an Indian Health Service Buy Indian Act Indian Firm Representation Form template used for federal contract solicitations. The form requires offerors to self-certify that they meet the definition of an "Indian Firm" with "Indian Ownership" as defined under 25 U.S.C. 47 and HHSAR regulations 326.602 and 326.603. The specific solicitation referenced is IHS-SS-26-1522549 for an Ultrasound System for Kyle Health Center, dated 07/09/2026.
Offerors must maintain Indian Firm status at three critical points: when submitting an offer, at contract award, and throughout the full contract performance period. Any loss of eligibility during these periods requires immediate written notification to the Contracting Officer. Successful offerors must register with Dun & Bradstreet (D&B) and the System of Award Management (SAM). The form includes checkboxes for the offeror to represent whether or not it meets the Indian Firm definition and requires the offeror's business name, DUNS number, certifying signature, and printed name. False or misleading information submitted in connection with a Buy Indian Act set-aside award violates 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.
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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.
Business Name Certifying Signature
DUNS Number Print Name
| SOLICITATION NUMBER: IHS-SS-26-1522549 |
| PROJECT TITLE: ULTRASOUND SYSTEM FOR KYLE HEALTH CENTER |
| DATE: 07/09/2026 |
| Business Name: |
| DUNS Number: |
| Print Name: |
| Check Box1: Off |
| Check Box2: Off |
File details come from the government source that posted it. Updated .