Indian Firm Representation Form.pdf
PDF 49 KB Posted
- Solicitation number
- IHS1507608
About this file
The Indian Firm Representation Form is a self-certification document for the Buy Indian Act, requiring offerors to verify their status as an "Indian Firm" with "Indian Ownership" for a federal contract opportunity. The form applies to solicitation number IHS1507608 for a Phase 1 ESA and HMAS project, and mandates that the enterprise must meet the Indian Firm definition at the time of offer, contract award, and throughout the entire contract performance period.
The document outlines critical compliance requirements, including immediate written notification to the Contracting Officer if eligibility criteria are no longer met. Offerors must also be registered with DUN and Bradstreet (D&B) and the System of Award Management (SAM). The form warns that false or misleading information can result in legal penalties under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731, emphasizing the serious nature of the self-certification process for this Indian Health Service contract opportunity.
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| File | Type | Posted |
|---|---|---|
| SOW 05022025_Kyle and Wanblee_Phase 1 ESA.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: IHS1507608 |
| PROJECT TITLE: Phase 1 ESA and HMAS |
| DATE: May 12, 2025 |
| Business Name: |
| DUNS Number: |
| Print Name: |
| Check Box1: Off |
| Check Box2: Off |
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