Indian Firm Representation Form.pdf
PDF 46 KB Posted
- Solicitation number
- Solicitation_75H70726Q00022
About this file
This document is an Indian Health Service (IHS) Buy Indian Act Indian Firm Representation Form, which requires offerors to self-certify as an "Indian Firm" with "Indian Ownership" in response to a federal solicitation. The form mandates that enterprises meet the "Indian Firm" definition at three critical points: when submitting an offer, at contract award, and throughout the entire contract performance period.
The form outlines specific compliance requirements, including immediate written notification to the Contracting Officer if eligibility status changes. Offerors must also be registered with Dun and Bradstreet (D&B) and the System of Award Management (SAM). The document emphasizes legal consequences for false or misleading information, with potential violations punishable under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731. Individual Contracting Officers retain the right to request documentation and may subject awards to protest if an offeror's eligibility is questionable.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_75H70726Q00022_Amd_0001.pdf | ||
| QA-Amend 0001.pdf | ||
| Past Performance Survey_Sol 75H70726Q00022.docx | DOCX document | |
| QA_.docx | DOCX document | |
| Sol_75H70726Q00022_terms and conditions.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: |
| PROJECT TITLE: |
| DATE: |
| Business Name: |
| DUNS Number: |
| Print Name: |
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