Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form.pdf
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- M-System Software License and Support
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- SS-26-IHS1523433-02
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About this file
This is an Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form used by the Department of Health & Human Services to establish self-certification of offeror eligibility for Indian Health Service contracts.
The form requires offerors to certify whether they meet the definition of an "Indian Economic Enterprise" (IEE) with "Indian Ownership" under the authority of the Buy Indian Act (25 U.S.C. 47) in response to Sources Sought Notices, Requests for Information (RFI), or Solicitations. Offerors must maintain eligibility at three critical junctures: at the time an offer is submitted, at the time of contract award, and throughout the full term of contract performance. Any loss of eligibility during these periods requires immediate written notification to the Contracting Officer. Individual Contracting Officers may require 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 also be registered with the System of Award Management (SAM). The form requires the offeror to provide the name of the Federally Recognized Tribal Entity, the name of the 51% owner of the IEE firm, business name, Unique Entity Identifier (UEI) number, certifying signature, and printed name. False or misleading information submitted in connection with an offer for a Buy Indian Act set-aside award violates federal law and is punishable under 18 U.S.C. 1001, while false claims submitted 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
SOLICI ATION : _________________________________________________
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 ” (HHSAR 326.60 ) in response to this olicitation and resultant contract.
The enterprise must meet the definition of “Indian ” 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 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.
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