Indian Firm Representation Form - Attachment 2.pdf
PDF 46 KB Posted
- Attached to
- Division of Diabetes Treatment and Prevention Clearinghouse and Warehouse Support Services
- Solicitation number
- 75H70424R00002A
About this file
This document is an Indian Firm Representation Form for a federal contract opportunity. The form allows an offeror to self-certify that it meets the definition of an "Indian Firm" with "Indian Ownership" under the Buy Indian Act. The solicitation is a Request for Proposal (RFP) for a fixed-price purchase order to provide clearinghouse and warehouse support services to the Indian Health Service's Office of Clinical and Preventive Services - Division of Diabetes Treatment and Prevention. The contract will have a one-year base period and four one-year option periods. The procurement is a total Indian Small Business Economic Enterprise set-aside under NAICS code 493110. Proposals are due by 11:59 PM EST on May 25, 2024 and should be valid for 30 days. The contract will be awarded to the responsible offeror whose offer is most advantageous to the Government, with technical capability, past performance, and price being the evaluation factors.
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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: |
| PROJECT TITLE: |
| DATE: |
| Business Name: |
| DUNS Number: |
| Print Name: |
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