SELF CERT BUY INDIAN ACT.pdf

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DELL SERVERS, POWEREDGE R660 RACK SERVER
Solicitation number
75H71325Q00035
Issued by

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This document is an Indian Firm Representation Form for the Buy Indian Act, related to a solicitation for Dell PowerEdge R660 Rack Servers for the Indian Health Service's Portland Area Office. The form requires self-certification that an offeror meets the definition of an "Indian Firm" with "Indian Ownership" under 25 U.S.C. 47, and must maintain this status throughout the solicitation, award, and contract performance periods. The solicitation (Number 75H71325Q00035) is a sources sought notice seeking information from vendors about their capabilities to provide two Dell servers, with a preference for Indian Small Business Economic Enterprises (ISBEE) and/or Indian Economic Enterprises (IEE). Vendors must be registered in the System for Award Management (SAM) and provide details including business name, point of contact, UEID number, NAICS code, business size, and classification. Delivery will be to the Portland Area Indian Health Service office, with specific constraints on delivery times and site access.

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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: 75H71325Q00035
PROJECT TITLE: DELL SERVERS, POWEREDGE R660 RACK SERVER
DATE:
Business Name:
DUNS Number:
Print Name:

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