J07 IHS IEE Representation Form.pdf
PDF 953 KB Posted
- Attached to
- RFP Stephan Booster Station & WM Replace Federal contract opportunity
- Solicitation number
- RFP75H70125R00046
About this file
This is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form for solicitation number 75H70125R00046, titled "Stephan Booster Station & WM Replace". The form requires businesses to self-certify whether they meet the definition of an "Indian Economic Enterprise" with Indian ownership, which must be maintained at the time of offer, contract award, and throughout the contract performance period. Offerors must be registered in the System of Award Management (SAM) and can face legal penalties for submitting false information.
The associated federal contract opportunity is a set-aside for an Indian Small Business Economic Enterprise, involving the removal and replacement of an existing Stephan Booster Station and approximately 9,900 linear feet of ductile iron pipe. The Indian Health Service intends to award a single Firm Fixed Price (FFP) contract using a Request for Proposal (RFP) with Lowest Price Technically Acceptable (LPTA) evaluation criteria. All solicitation documents will be posted online, and hard copy documents will not be available. Contractors are required to check https://www.sam.gov for amendments and changes to the solicitation.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B05-A01 QA SBSWM Repl.pdf | ||
| RFP 25R00046 Stephan Booster Station WM Replace.pdf | ||
| J08 Company Specialized Experience Form Construction.pdf | ||
| J10 WH-347 Exp 31Jan2028.pdf | ||
| J01 SOW SBSWM Repl.pdf | ||
| J11 Release of Claims.docx | DOCX document | |
| J04 Map of Project Location.pdf | ||
| J03 Stephan Booster WM_Specs.pdf | ||
| J02 Stephan Booster WM_Plans.pdf | ||
| J05 Wage Det SD20250007 14Mar2025.pdf | ||
| J06 Self Performed Calculation Sheet.docx | DOCX document | |
| J09 Past Performance Questionnaire.docx | DOCX document |
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Office of Management Services Division of Acquisition Policy (DAP)
5600 Fishers Lane Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
SOLICITATION/SOURCES SOUGHT/RFI #: ______________________________________
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 Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.
The enterprise must meet the definition of “Indian Economic Enterprise” 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 Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.
Name of the 51% owner of IEE Firm
Certifying Signature
Print Name
Name of Federally Recognized Tribal Entity
Business Name
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: 75H70125R00046 |
| PROJECT_TITLE: Stephan Booster Station & WM Replace |
| DoesNot: 0 |
| Does: Off |
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