Manual_Exhibit_5-5_1A_IEERepresentationForm.pdf
PDF 129 KB Posted
- Attached to
- IHS1449677 - VoiP - PAO Federal contract opportunity
- Solicitation number
- RFQ-22-PHX-049
About this file
This document is a combined synopsis and solicitation from the Department of Health and Human Services Indian Health Service seeking quotes for a Voice over IP (VoIP) system. The solicitation is set aside 100% for small businesses and offers a tiered evaluation preference first for Indian Small Business Economic Enterprises, then other small businesses, and if no award can be made, other than small businesses. Quotes are due by August 15, 2022 and include equipment, software, installation and configuration of a Cisco Unified Communications system including Cisco Unified Communications Manager, Cisco Unity Connection, and Singlewire InformaCast for Paging across 11 regional service units in central Arizona, northern Nevada and Northwestern Utah. The required equipment is listed in the statement of work and bill of materials. The technical approach, past performance, and price will be evaluated, with technical and past performance being more important than price. Price shall be submitted as a firm fixed price using the provided price schedule.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2022 Hospital - Phoenix Area Indian Health Service.pdf | ||
| F - QNA.pdf | ||
| SOW.pdf | ||
| Attm 2 Gray Market.pdf | ||
| Pricing Schedule.xlsx | XLSX spreadsheet | |
| RFQ.pdf |
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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: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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