Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form.pdf
PDF 814 KB Posted
- Attached to
- M Hendrickx Connection to City of Spokane Water
- Solicitation number
- 75H70126Q00032
About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form used for federal contract solicitations.
The form is a self-certification document required from offerors responding to Indian Health Service solicitations set aside under the Buy Indian Act authority (25 U.S.C. 47). The specific solicitation referenced is 75H70126Q00032 for the "M Hendrickx Connection to City of Spokane Water" project. Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" as defined in EHSAR 326.601 at three critical junctures: when submitting an offer, at the time of contract award, and throughout the full contract performance period. If a contractor no longer meets eligibility requirements during any of these periods, immediate written notification to the Contracting Officer is mandatory. The form requires completion of fields including the federally recognized tribal entity name, business name, DUNS number, name of the 51% owner of the Indian Economic Enterprise firm, and the certifying signature with printed name. Contractors must also register with the System of Award Management (SAM) following successful award. False or misleading information submitted by an enterprise is punishable under 18 U.S.C. 1001, and false claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Servic
Division of Acquisition Policy 5600 Fishers Lane
Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
IN
REPRESENTATION FORM
(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 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 ” with “Indian Ownership” under the authority of the Buy Indian Act.
SOLICI ATION : __75H70126Q00032_________
PROJECT TITLE: M Hendrickx Connection to City of Spokane Water_
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 ” (HHSAR 326.60 ) in response to this olicitation and resultant contract.
The enterprise must meet the definition of “Indian ” throughout the following time periods:
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