Indian Firm Representation Form 26Q00210.pdf
PDF 49 KB Posted
- Attached to
- ISBEE Set-Aside: EMS cot for Pine Ridge Service Unit Federal contract opportunity
- Solicitation number
- 75H70626Q00210
About this file
This is an Indian Health Service Buy Indian Act Indian Firm Representation Form used for federal contract solicitations. The form serves as a self-certification document for offerors to declare whether they meet the definition of an "Indian Firm" with "Indian Ownership" as defined under 25 U.S.C. 47 and the Health and Human Services Acquisition Regulation (HHSAR) sections 326.602 and 326.603.
The specific solicitation referenced is 75H70626Q00210 for "EMS COT FOR PINE RIDGE HOSPITAL," dated July 23, 2026. Offerors must maintain Indian Firm 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 requires immediate written notification to the Contracting Officer. The form requires offerors to provide their business name, DUNS number, certifying signature, and printed name. Successful offerors must be registered with Dun & Bradstreet (D&B) and the System of Award Management (SAM). The form warns that false or misleading information submitted in connection with Buy Indian Act set-aside awards violates 18 U.S.C. 1001, with false claims during contract performance subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287. Contracting Officers may require 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 for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 75H70626Q00210.pdf | ||
| SOW_EMS cot.pdf | ||
| Synopsis 75H70626Q00210.pdf | ||
| Past_Performance_Questionnaire.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.
Business Name Certifying Signature
DUNS Number Print Name
| SOLICITATION NUMBER: 75H70626Q00210 |
| PROJECT TITLE: EMS COT FOR PINE RIDGE HOSPITAL |
| DATE: 7/23/2026 |
| Business Name: |
| DUNS Number: |
| Print Name: |
| Check Box1: Off |
| Check Box2: Off |
File details come from the government source that posted it. Updated .