Indian Firm Representation Form.pdf
PDF 272 KB Posted
- Attached to
- Sources Sought: Dental Supplies for the Woodrow Wilson Keeble Memorial Health Care Center, Sisseton SD
- Solicitation number
- IHS1524727
About this file
This is an Indian Firm Representation Form required by the Indian Health Service (IHS) for the Buy Indian Act procurement set-aside.
The form applies to solicitation number IHS1524727 for Dental Supplies, dated March 27, 2026. Offerors must self-certify that they meet the definition of an "Indian Firm" with "Indian Ownership" as defined in HHSAR 326.602 and 326.603, respectively, under the authority of 25 U.S.C. 47. The enterprise must maintain eligibility status at three critical points: when the offer is submitted, at the time of contract award, and throughout the entire contract performance period. Any loss of eligibility during these periods requires immediate written notification to the Contracting Officer. Contracting Officers may request documentation of eligibility before awarding set-aside or sole source contracts, and awards are subject to protest if the successful Offeror's eligibility is questioned. Successful Offerors must be registered with both Dun and Bradstreet (D&B) and the System of Award Management (SAM). The form includes a representation section where the offeror certifies whether or not it meets the Indian Firm definition, and requires the business name, DUNS number, certifying signature, and printed name of the authorized representative.
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Other files
| File | Type | Posted |
|---|---|---|
| IHS1524727 Specification Sheet.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: IHS1524727 |
| PROJECT TITLE: Dental Supplies |
| DATE: 03/27/2026 |
| Business Name: |
| DUNS Number: |
| Print Name: |
File details come from the government source that posted it. Updated .