SELF CERT BUY INDIAN ACT.pdf

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Attached to
Preventative Maintenance & Inspection Services of biomedical equipment
Solicitation number
75H71327Q00002
Issued by

About this file

This is an Indian Firm Representation Form required by the Indian Health Service (IHS) Division of Acquisition Policy for federal contract solicitations under the Buy Indian Act authority. The form applies to Solicitation Number 75H71327Q00002 for Preventative Maintenance & Inspection of biomedical equipment.

The form establishes self-certification requirements for offerors claiming "Indian Firm" status with "Indian Ownership" as defined under 25 U.S.C. 47 and HHSAR regulations 326.602 and 326.603. Offerors must maintain eligibility at three critical junctures: at the time of offer submission, at contract award, and throughout the entire contract performance period. Any change in eligibility status requires immediate written notification to the Contracting Officer. Contracting Officers may request documentation to verify 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 maintain current registration with Dun & Bradstreet (D&B) and the System of Award Management (SAM). The form includes a representation section where offerors certify whether they do or do not meet the Indian Firm definition, with signature blocks for the business name, certifying signature, UEID number, and printed name. False or misleading information submitted in connection with a Buy Indian Act award is punishable under 18 U.S.C. 1001, and false claims 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 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.

Certifying Signature

Business Name

UEID Number Print Name

SOLICITATION NUMBER: 75H71327Q00002
PROJECT TITLE: Preventative Maintenance & Inspection of biomedical equipment
DATE:
Business Name:
DUNS Number:
Print Name:
Check Box1: Off
Check Box2: Off

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