SELF CERT BUY INDIAN ACT.pdf
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- Attached to
- 75H71325Q00046 DENTAL EQUIPMENT
- Solicitation number
- 75H71325Q00046
About this file
This document is an Indian Firm Representation Form for the Buy Indian Act, specifically for a dental equipment solicitation by the Indian Health Service (IHS). The form requires self-certification that an offeror meets the definition of an "Indian Firm" with "Indian Ownership" under 25 U.S.C. 47, applicable at the time of offer, contract award, and throughout contract performance. The form warns that false or misleading information is punishable under federal law, and requires registration with D-U-N-S and the System of Award Management (SAM).
The associated solicitation (75H71325Q00046) seeks dental equipment for the Yakama Service Unit in Toppenish, Washington, including specific Kavo brand items: Prophy WIZ (6 packs), Intraflex Lux2 Shank (15 units), and Experttorue Mini Lux E675L (15 units). The procurement is set aside under the Buy Indian Act, first soliciting Indian Small Business Economic Enterprises, with a secondary tier of other small business concerns if insufficient competitive offers are received. Quotes are due by 12:00 pm PST on 08/06/2025, to be emailed to Morningstar.Smith@ihs.gov, with a required self-certification form and specific email subject line identifier.
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Text version
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: 75H71325Q00046 |
| PROJECT TITLE: DENTAL EQUIPMENT FOR YAKAMA SERVICE UNIT |
| DATE: |
| Business Name: |
| DUNS Number: |
| Print Name: |
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