Solicitation_75H71026Q00248.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CODE 16. ADMINISTERED BYCODE

X

X

325413

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR17

REQUEST FOR

PROPOSAL

(RFP)

INVITATION

FOR BID (IFB)

10. THIS ACQUISITION ISCODE

REQUEST FOR

QUOTE (RFQ)

14. METHOD OF SOLICITATION

13b. RATING

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SMALL BUSINESS

08/25/2026 1700 MT

08/11/2026

NORA NUTLOUIS

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71026Q00248

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 25 IHS1522669OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Chinle AZ 86503

Highway 191 Hospital Drive

PO Drawer PH

Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

1,250

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS THIS CONTRACT IS A RATED

ORDER UNDER THE DEFENSE

PRIORITIES AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

8(A)

Chinle Comprehensive Hlth Care Fac WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

Multiple Destinations

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This is a Request for Quote (RFQ) for a contractor to provide a Blanket Purchase Agreement (BPA) to purchase Quality Control Materials for Chemistry testing supplies.

Supplies will be purchased on as needed basis to the Laboratory Department at Chinle Comprehensive Health Care Facility, Navajo Area Indian Health Service (IHS). Supplies shall be in strict accordance with attached specifications.

Resultant contract type will be a firm fixed priced contract.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

TANYA M. JOHNSON

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Government Use Only)

OFFER

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT: REFERENCE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 11/2021) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Per RFO 6.103-1(d) the Government has identified a specific brand name but will accept brand-name or equal descriptions.

Note to Vendor: Refer to section 52.212-1

INSTRUCTIONS TO OFFERORS – COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES.

Period of Performance: 09/01/2026 to 08/31/2027

1 Base Period (12 months) 09/01/2026 to 08/31/2027

SUPPLIES

Item Description - Pediatric 2 LIQ

Quantity = 12 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Specialty IA LIQ 1

Quantity = 13 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Specialty IA LIQ 2

Quantity = 13 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Viroclear

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

25 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 25

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71026Q00248

Quantity = 50 each

Unit Price =$_____________

Extended Price =$___________

Item Description - Virotrol I

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-1

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-2

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-1 gO

Quantity = 12 each

Unit Price =$_____________

Extended Price =$_____________

2 Base Period (12 months) 09/01/2026 to 08/31/2027

Shipping – all types of shipping costs

Quantity = 12 months

Monthly Price = $_____________

Extended Price = $_____________

3 First Option Period (12 months) 09/01/2027 to

08/31/2028

SUPPLIES

Item Description - Pediatric 2 LIQ

Quantity = 12 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Specialty IA LIQ 1

Quantity = 13 each

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

4 25

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71026Q00248

Unit Price =$_____________

Extended Price =$_____________

Item Description - Specialty IA LIQ 2

Quantity = 13 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Viroclear

Quantity = 50 each

Unit Price =$_____________

Extended Price =$___________

Item Description - Virotrol I

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-1

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-2

Quantity = 50 each

Unit Price =$_____________

Extended Price =$_____________

Item Description - Virotrol Hiv-1 gO

Quantity = 12 each

Unit Price =$_____________

Extended Price =$_____________

(Option Line Item)

08/31/2027

Period of Performance: 09/01/2027 to 07/31/2028

4 First Option Period (12 months) 09/01/2027 to

08/31/2028

Shipping – all types of shipping costs

Quantity = 12 months

Monthly Price = $_____________

Extended Price = $_____________

(Option Line Item)

08/31/2027

Period of Performance: 09/01/2027 to 07/31/2028

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

Rev. 04/29/2026

SECTION B – CONTINUATION OF SF-1449

This page intentionally left blank.

SECTION C – CONTRACT CLAUSES

52.212-4 CONTRACT TERMS AND CONDITIONS –

COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

The following Federal Acquisition Regulation clauses also apply:

☐ 52.203-3 GRATUITIES APR 1984

☐ 52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT Alt I

NOV 2021

☐ 52.203-12 LIMITATION OF PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS

JUN 2020

☐ 52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT NOV 2021

☐ 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST JUN 2020

☒ 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS NOV 2023

☒ 52.203-19 PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS

JAN 2017

☐ 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL JAN 2011

☒ 52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE NOV 2025

(DEVIATION)

☐ 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-

DELIVERY CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.204-91 CONTRACTOR IDENTIFICATION NOV 2025

(DEVIATION)

☒ 52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN

SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR

PROPOSED FOR DEBARMENT

NOV 2025

(DEVIATION)

☐ 52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING

RESPONSIBILITY MATTERS

NOV 2025

(DEVIATION)

☒ 52.209-10 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC

CORPORATIONS

NOV 2025

(DEVIATION)

☐ 52.213-1 RESERVED

☐ 52.219-3 NOTICE OF HUBZONE SET-ASIDE OR SOLE-SOURCE AWARD NOV 2025

(DEVIATION)

☐ 52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE NOV 2025

(DEVIATION)

☐ 52.219-6 Alt I

NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.219-7 NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE NOV 2020

☐ 52.219-7 Alt I

NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I MAR 2020

☐ 52.219-8 UTILIZATION OF SMALL BUSINESS CONCERNS NOV 2025

(DEVIATION)

☐ 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-9 Alt I

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.219-9 Alt II

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.219-9 Alt III

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE III NOV 2025

(DEVIATION)

☐ 52.219-9 Alt IV

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE IV NOV 2025

(DEVIATION)

☐ 52.219-13 NOTICE OF SET-ASIDE OF ORDERS MAR 2020

☐ 52.219-13 Alt I

RESERVED

☐ 52.219-16 LIQUIDATED DAMAGES—SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-27 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) CONCERNS

ELIGIBLE UNDER THE SDVOSB PROGRAM

NOV 2025

(DEVIATION)

☒ 52.219-28 POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION NOV 2025

(DEVIATION)

☐ 52.219-28 Alt I

POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

☐ 52.219-29 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO,

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS

CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-30 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, WOMEN-

OWNED SMALL BUSINESS CONCERNS ELIGIBLE UNDER THE WOMEN-

OWNED SMALL BUSINESS PROGRAM

NOV 2025

(DEVIATION)

☐ 52.219-33 NONMANUFACTURER RULE NOV 2025

(DEVIATION)

☒ 52.222-3 CONVICT LABOR NOV 2025

(DEVIATION)

☒ 52.222-19 CHILD LABOR—COOPERATION WITH AUTHORITIES AND REMEDIES NOV 2025

(DEVIATION)

☐ 52.222-35 EQUAL OPPORTUNITY FOR VETERANS NOV 2025

(DEVIATION)

☒ 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES NOV 2025

(DEVIATION)

☐ 52.222-36

ALT I

EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES, WITH

ALTERNATE I

JUL 2014

☐ 52.222-37 EMPLOYMENT REPORTS ON VETERANS NOV 2025

(DEVIATION)

☐ 52.222-40 NOTIFICATION OF EMPLOYEE RIGHTS UNDER THE NATIONAL LABOR

RELATIONS ACT

NOV 2025

☐ 52.222-41 SERVICE CONTRACT LABOR STANDARDS NOV 2025

(DEVIATION)

☐ 52.222-43 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT (MULTIPLE YEAR AND OPTION

CONTRACTS)

NOV 2025

(DEVIATION)

☐ 52.222-44 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT

NOV 2025

(DEVIATION)

☒ 52.222-50 COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-50 Alt I

COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-51 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR MAINTENANCE, CALIBRATION, OR

REPAIR OF CERTAIN EQUIPMENT—REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-53 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR CERTAIN SERVICES—

REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-54 EMPLOYMENT ELIGIBILITY VERIFICATION NOV 2025

(DEVIATION)

☐ 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER EXECUTIVE

ORDER 14026

NOV 2025

(DEVIATION)

☐ 52.222-62 PAID SICK LEAVE UNDER EXECUTIVE ORDER 13706 NOV 2025

(DEVIATION)

☒ 52.222-90 ADDRESSING DEI DISCIMINATION BY FEDERAL CONTRACTORS APR 2026

(DEVIATION)

☐ 52.223-2 REPORTING OF BIOBASED PRODUCTS UNDER SERVICE AND

CONSTRUCTION CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.223-5 POLLUTION PREVENTION AND RIGHT-TO-KNOW INFORMATION MAY 2024

☐ 52.223-11 OZONE-DEPLETING SUBSTANCES NOV 2025

(DEVIATION)

☐ 52.223-12 MAINTENANCE, SERVICE, REPAIR, OR DISPOSAL OF REFRIGERATION

EQUIPMENT AND AIR CONDITIONERS

NOV 2025

(DEVIATION)

☒ 52.223-23 SUSTAINABLE PRODUCTS NOV 2025

(DEVIATION)

☐ 52.224-1 PRIVACY ACT NOTIFICATION APR 1984

☐ 52.224-2 PRIVACY ACT APR 1984

☐ 52.224-3 PRIVACY TRAINING JAN 2017

☐ 52.224-3

ALT I

PRIVACY TRAINING, WITH ALTERNATE I JAN 2017

☒ 52.225-1 BUY AMERICAN-SUPPLIES NOV 2025

(DEVIATION)

☐ 52.225-1 Alt I

BUY AMERICAN-SUPPLIES, WITH ALTERNATE I OCT 2022

☐ 52.225-3 BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT NOV 2025

52.225-3

ALT I

RESERVED

☐ 52.225-3 Alt II

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE II

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt III

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE III

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt IV

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE IV

NOV 2025

(DEVIATION)

☐ 52.225-5 TRADE AGREEMENTS NOV 2023

☐ 52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF

CONTRACT

FEB 2000

☐ 52.225-19 CONTRACTOR PERSONNEL IN A DESIGNATED OPERATIONAL AREA OR

SUPPORTING A DIPLOMATIC OR CONSULAR MISSION OUTSIDE THE

UNITED STATES

MAY 2020

☐ 52.225-26 CONTRACTORS PERFORMING PRIVATE SECURITY FUNCTIONS

OUTSIDE THE UNITED STATES

OCT 2016

☒ 52.226-1 UTILIZATION OF INDIAN ORGANIZATIONS AND INDIAN-OWNED

ECONOMIC ENTERPRISES

NOV 2025

(DEVIATION)

☐ 52.226-5 RESTRICTIONS ON SUBCONTRACTING OUTSIDE DISASTER OR

EMERGENCY AREA

NOV 2025

(DEVIATION)

☐ 52.226-6 PROMOTING EXCESS FOOD DONATION TO NONPROFIT

ORGANIZATIONS

NOV 2025

(DEVIATION)

☒ 52.226-8 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING

WHILE DRIVING

MAY 2024

☐ 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS AUG 2025

(DEVIATION)

☒ 52.232-18 AVAILABILITY OF FUNDS APR 1984

☐ 52.232-29 TERMS FOR FINANCING OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☐ 52.232-30 INSTALLMENT PAYMENTS OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☒ 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER—SYSTEM FOR AWARD

MANAGEMENT

OCT 2018

☐ 52.232-34 PAYMENT BY ELECTRONIC FUNDS TRANSFER—OTHER THAN SYSTEM

FOR AWARD MANAGEMENT

JUL 2013

☐ 52.232-36 PAYMENT BY THIRD PARTY NOV 2025

(DEVIATION)

☒ 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

MAR 2023

☐ 52.232-90 FAST PAYMENT PROCEDURE NOV 2025

(DEVIATION)

☒ 52.233-3 PROTEST AFTER AWARD NOV 2025

(DEVIATION)

☒ 52.233-4 APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM NOV 2025

(DEVIATION)

☐ 52.237-2 PROTECTION OF GOVERNMENT BUILDING, EQUIPMENT, AND

VEGETATION

APR 1984

☐ 52.237-3 CONTINUITY OF SERVICES JAN 1991

☒ 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS NOV 2025

(DEVIATION)

☐ 52.240-91 Alt I

SECURITY PROHIBITIONS AND EXCLUSIONS, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.240-92 SECURITY REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.240-92 Alt II

SECURITY REQUIREMENTS WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.240-93 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS

NOV 2025

(DEVIATION)

☐ 52.242-5 PAYMENTS TO SMAL BUSINESS SUBCONTRACTORS JAN 2017

☐ 52.242-13 BANKRUPTCY JUL 1995

☐ 52.244-2 SUBCONTRACTS JUN 2020

☒ 52.244-6 SUBCONTRACTS FOR COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

☐ 52.245-1 GOVERNMENT PROPERTY SEP 2021

☐ 52.245-2 GOVERNMENT PROPERTY INSTALLATION OPERATION SERVICES APR 2012

☐ 52.245-9 USE AND CHARGES APR 2012

☐ 52.247-64 PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS

NOV 2025

(DEVIATION)

☐ 52.247-64 Alt I

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE I

APR 2003

☐ 52.247-64 Alt II

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE II

NOV 2021

52.217-8 OPTION TO EXTEND SERVICES NOV 1999

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within “before the contract expires”.

(End of clause)

52.217-9 OPTION TO EXTEND THE TERM OF THE

CONTRACT MAR 2000

(a)The Government may extend the term of this contract by written notice to the Contractor within “before the contract expires” provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least __10_ days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b)If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c)The total duration of this contract, including the exercise of any options under this clause, shall not exceed ___2___years.

52.252-2 CLAUSES INCORPORATED BY REFERENCE FEB 1998

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES NOV 2020

(a)The use in this solicitation or contract of any Federal Acquisition Regulation (48 CFR Chapter 1) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation or contract of any Department of Health and Human Services (48 CFR Chapter 3) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

The following Department of Health and Human Services Acquisition Regulation clauses also apply:

☐ 352.203-70 ANTI-LOBBYING DEC 2015

☐ 352.208-70 PRINTING AND DUPLICATION DEC 2015

☐ 352.211-3 PAPERWORK REDUCTION ACT DEC 2015

☐ 352.219-71 MENTOR-PROTÉGÉ PROGRAM REPORTING REQUIREMENTS JAN 2010

☐ 352.223-70 SAFETY AND HEALTH DEC 2015

☐ 352.224-70 PRIVACY ACT DEC 2015

☒ 352.226-6 INDIAN ECONOMIC ENTERPRISE SUBCONTRACTING

LIMITATIONS

MAR 2022

☐ 352.227-70 PUBLICATIONS AND PUBLICITY DEC 2015

☐ 352.231-70 SALARY RATE LIMITATION DEC 2015

☐ 352.237-70 PRO-CHILDREN ACT DEC 2015

☐ 352.237-71 CRIME CONTROL ACT – REPORTING OF CHILD ABUSE DEC 2015

☐ 352.237-72 CRIME CONTROL ACT – REQUIREMENTS FOR BACKGROUND

CHECKS

DEC 2015

☐ 352.237-73 INDIAN CHILD PROTECTION AND FAMILY VIOLENCE ACT DEC 2015

352.232-71 ELECTRONIC SUBMISSION OF PAYMENT

REQUESTS

APR 2026

(a) Definitions. As used in this clause –

Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements in FAR 32.905(b) and the applicable payment clause included in this contract.

(b) Submission instructions. Except as provided in paragraph (c) of this clause, the Contractor must submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) Alternate submission procedures. The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing.

(d) Submission of alternate payment procedures authorization. If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer’s written authorization with each payment request

The following local Indian Health Service, Navajo Area terms also apply:

NAIHS-ACQ-08 CONTRACTING OFFICER’S REPRESENTATIVE NOV 2025

(a) Definition. “Contracting Officer’s Representative (COR)” means an individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the contracting officer to perform specific technical or administrative functions.

(b) Per FAR Subpart 1.404(a): The Contracting Officer (CO) determines that this contract requires a Contracting Officer Representative (COR).The Contracting Officer Representative (COR) is:

Colleen Ben

(c) Upon award, the COR will receive a copy of the written designation, specifying the extent of the COR’s authority on behalf of the CO.

(d) Limitations.

(1) The COR has no authority to make any commitments or changes that affect price, quality, quantity, delivery, or other terms and conditions of the contract.

(2) The COR must not direct the contractor or its subcontractors to operate in conflict with the contract terms and conditions.

(End of Clause)

NAIHS-ACQ-09 UNAUTHORIZED COMMITMENTS NOV 2025

(a) Definitions.

Contracting Officer means a person with the authority to enter into, administer, and/or terminate contracts and make related determination and findings.

Ratification means the act of approving an unauthorized commitment by an official who has the authority to do so.

Unauthorized Commitment (UAC) means an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government.

(b) Policy.

The Government is not bound by agreements with, or contractual commitments made to, prospective contractors by individuals who do not have delegated contracting authority. Unauthorized commitments do not follow the appropriate process for the expenditure of Government funds. Consequently, the Government may not be able to ratify certain actions, putting a contractor at risk for taking direction from a Federal official other than the contracting officer (see FAR 1.403-2). Government employees responsible for unauthorized commitments are subject to disciplinary action. Contractors perform at their own risk when accepting direction from unauthorized officials. Failure to follow statutory and regulatory processes for the expenditure of Government funds is a very serious matter.

(c) Procedure.

Any agreement, modification, or change to a contractual agreement made by a government personnel who lack authority will be deemed an unauthorized commitment. The Government is not liable to the Contractor or under the terms of the contract, financially or otherwise – unless the unauthorized commitment successfully passes the ratification process.

The ratification process does not have any lead time, nor does the Government make any promise that an unauthorized commitment will be ratified and, therefore, the Contractor would be paid. The Contractor proceeds at its own risk if any of the terms of the contract are altered, changed, or modified without the written concurrence by a Contracting Officer.

NAIHS-ACQ-20 PROTECTING FEDERAL EMPLOYEES AND THE PUBLIC

FROM EXPOSURE TO TOBACCO SMOKE IN THE

FEDERAL WORKPLACE

APR 2026

In accordance with Executive Order 13058 “Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace,” and the Assistant Secretary for Health memorandum “Prohibition of Tobacco Use in HHS Occupied Facilities,” the use of tobacco products, in any form, is strictly prohibited at IHS-operated properties including, but not limited to:

1. All interior and exterior spaces of IHS-operated properties.

2. All HIS-operated spaces in multi-tenant buildings.

3. All Government vehicles regardless of their location.

4. Private vehicles while on IHS property.

The IHS continues to recognize the value and efficacy of patients’ traditional beliefs and ceremonial practices. The use of tobacco products for ceremonial purposes is allowed in the designated traditional healing room, including any space designated for a ceremony, or in a patient’s hospital room.

To the maximum extent practicable, Contractor must notify the Contracting Officer’s Representative in advance of using tobacco products in a ceremony.

SECTION D – DOCUMENTS, EXHIBITS, ATTACHMENTS, ETC.

Attachment A – Supply List

Attachment B – IHS-IEE Representation Form

SECTION E – SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

Addenda are not included. 52.212-1 Instructions to Offerors – Commercial Products and Commercial Services for Submission of Offers. All offers must include the following information and submitted at or before the date and time specified in this solicitation.

(a) Submission of offers. All quotes must include the following information and emailed to the Contracting Officer (CO): Nora Nutlouis, Purchasing Agent, 928-725-9806, nora.nutlouis@ihs.gov at or before the exact time specified in this solicitation. As a minimum, quotes shall include—

(1) The solicitation number;

(2) The name, address, telephone number of the Quoter;

(3) The Offeror’s Unique Entity Identifier (UEI) and, if applicable, Electronic Funds Transfer (EFT) indicator;

(4) Information necessary to evaluate the factors contained in the provision at 52.212-2 or as described in the solicitation;

a) Volume 1 – Label “Administrative Documents.” Provide signed and dated SF-1449 and all associated SF-30 amendments, if any. Provide a completed IHS IEE Representation Form attachment. Quote that fail to provide required administrative documents or reject the Terms and Conditions of the solicitation may be excluded from consideration.

b) Volume 2 – Label “Technical Capability/Specifications.” Provide evidence that your item can meet or exceed the attached Specifications.

NO PRICING INFORMATION SHALL BE INCLUDED IN VOLUMES 2

c) Volume 3 – Label “Price.” Provide detailed pricing aligned with the technical approach on SF1449. Include a narrative that supports the pricing and indicate any discount terms. All prices, base and option CLINs, must be quoted or the quote will not be considered.

Submission Format:

§ All Documentation must be in PDF format. Failure to follow instructions and/or to provide required information may render proposal nonresponsive or unacceptable and will be removed from award consideration.

§ Each volume must be submitted as a separate file with clear labeling (e.g., Volume I “Administrative Documents, etc.)

§ The email subject line should reference the solicitation number and quoter name.

§ Questions and Answers (Q&A) Period: The due date for all questions associated with this solicitation is (10) days before of offer due date. Questions requesting changes to solicitation/contract requirements will be considered only when supported by specific reasoning about how the change would increase competition/benefit the Government.

(5) Responses to provisions that require Offeror completion of information, representations, and certifications (other than those collected via the System for Award Management (SAM)); and

(6) A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation and any solicitation amendments.

(b) Period for acceptance of offers. The Offeror agrees to hold the prices in its offer firm for 60 calendar days from the date specified for receipt of offers, unless another time period is specified in an addendum to the solicitation.

(c) Late submissions, modifications, revisions, and withdrawals of offers.

(1) Offerors are responsible for submitting offers and any modifications or revisions to the Government office designated in the solicitation by the time specified in the solicitation.

(2) Any offer, modification, or revision received after the time specified for receipt of offers is “late” and will not be considered unless it is received before award is made and the Contracting Officer determines that accepting the late offer would not unduly delay the acquisition. However, a late modification of an otherwise successful offer that makes its terms more favorable to the Government will be considered at any time it is received and may be accepted.

(3) If an emergency or unanticipated event interrupts normal Government processes so that offers cannot be received at the Government office designated for receipt of offers by the exact time specified in the solicitation, and urgent Government requirements preclude amendment of the solicitation or other notice of an extension of the closing date, the time specified for receipt of offers will be deemed to be extended to the same time of day specified in the solicitation on the first work day on which normal Government processes resume.

(4) Offerors may withdraw their offers by written notice to the Government received at any time before award.

(d) Contract award (not applicable to Invitation for Bids). The Government intends to evaluate offers and award a contract without discussions with Offerors. Therefore, the Offeror’s initial offer should contain the Offeror’s best terms. However, the Government reserves the right to conduct discussions, if necessary. The Government may reject any or all offers if such action is in the public interest, accept other than the lowest offer, and waive informalities and minor irregularities in offers received.

(e) Debriefings. If a postaward debriefing is given to requesting Offerors, the Government will disclose the following information, if applicable:

(1) The agency’s evaluation of the significant weak or deficient factors in the debriefed Offeror’s offer.

(2) The overall evaluated cost or price and technical rating of the successful Offeror and the debriefed Offeror and past performance information on the debriefed Offeror.

(3) The overall ranking of all Offerors when any ranking was developed by the agency during source selection.

(4) A summary of the rationale for award.

(5) For acquisitions of commercial products, the make and model of the product to be delivered by the successful Offeror.

(6) Reasonable responses to relevant questions posed by the debriefed Offeror as to whether the agency followed source-selection procedures set forth in the solicitation, applicable regulations, and other applicable authorities.

(End of provision)

52.212-2 EVALUATION – COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

(a) Evaluation factors. The Government will award a contract resulting from this solicitation to the responsible Offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors will be used to evaluate quotes:

The Government reserves the right to issue a single award or multiple awards to the contractor(s) whose offer represents the Lowest Price Technically Acceptable (LPTA); award will be made on the basis of the lowest evaluated price of proposals meeting or exceeding the acceptability standards for non-cost factors.

Past Performance and Technical Capability when combined, are Significantly more important than cost or price, and all non-price factors are of equal importance. There will be no discussions.

(b) Options (if applicable). The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. The evaluation of options does not obligate the Government to exercise the option(s).

(c) Notice of award. A written notice of award or acceptance of an offer furnished to the successful Offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

The following Federal Acquisition Regulations provisions incorporated by reference also apply:

☐ 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO

INFLUENCE CERTAIN FEDERAL TRANSACTIONS

SEP 2024

52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE

CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR

STATEMENTS-REPRESENTATION

JAN 2017

☒ 52.204-7

SYSTEM FOR AWARD MANAGEMENT - REGISTRATION

NOV 2025

(DEVIATION)

☐ 52.204-7 Alt I

SYSTEM FOR AWARD MANAGEMENT—REGISTRATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

52.207-6 SOLICITATION OF OFFERS FROM SMALL BUSINESS CONCERNS AND

SMALL BUSINESS TEAMING ARRANGEMENTS OR JOINT VENTURES

(MULTIPLE-AWARD CONTRACTS)

AUG 2024

☐ 52.209-12 CERTIFICATION REGARDING TAX MATTERS OCT 2025

☐ 52.216-31 TIME-AND-MATERIALS/LABOR-HOUR PROPOSAL REQUIREMENTS –

COMMERCIAL ACQUISITION

NOV 2021

☐ 52.219-4 NOTICE OF PRICE EVALUATION PREFERENCE FOR HUBZONE SMALL

BUSINESS CONCERNS

☐ 52.219-31 NOTICE OF SMALL BUSINESS RESERVE MAR 2020

☐ 52.222-18 CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR

LISTED END PRODUCTS

FEB 2021

52.222-48 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR MAINTENANCE, CALIBRATION, OR REPAIR OF

CERTAIN EQUIPMENT–CERTIFICATION

MAY 2014

☐ 52.222-52 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR CERTAIN SERVICES-CERTIFICATION

MAY 2014

☐ 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS COMPLIANCE

PLAN

OCT 2020

☐ 52.223-1

BIOBASED PRODUCT CERTIFICATION

MAY 2024

☐ 52.223-4

RECOVERED MATERIAL CERTIFICATION

MAY 2008

☐ 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—NOTICE AND

REPRESENTATION

AUG 2025

(DEVIATION)

☐ 52.237-1

SITE VISIT

APR 1984

☒ 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS AND

CERTIFICATIONS

52.209-2 PROHIBITION ON CONTRACTING WITH

INVERTED DOMESTIC CORPORATIONS –

REPRESENTATION

(a) Definitions. As used in this clause—

Inverted domestic corporation means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

(b) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108-3(b) applies or the requirement is waived in accordance with the procedures at 9.108-5.

(c) Representation. The Offeror represents that-

(1) It □ is, □ is not an inverted domestic corporation; and

(2) It □ is, □ is not a subsidiary of an inverted domestic corporation.

52.209-11 REPRESENTATION BY CORPORATIONS

REGARDING DELINQUENT TAX LIABILITY OR A

FELONY CONVICTION UNDER ANY FEDERAL

LAW

(a) The Government will not enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that–

(1) It is □ is not □ a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability;

and

(2) It is □ is not □ a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

52.225-2 BUY AMERICAN CERTIFICATE OCT 2022

(a) (1) The Offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a domestic end product and that each domestic end product listed in paragraph (c) of this provision contains a critical component.

(2) The Offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products. For those foreign end products that do not consist wholly or predominantly of iron or steel or a combination of both, the Offeror shall also indicate whether these foreign end products exceed 55 percent domestic content, except for those that are COTS items. If the percentage of the domestic content is unknown, select “no”.

(3) The Offeror shall separately list the line item numbers of domestic end products that contain a critical component (see FAR 25.105).

(4) The terms “commercially available off-the-shelf (COTS) item,” “critical component,” "domestic end product," "end product," and "foreign end product" are defined in the clause of this solicitation entitled "Buy American-Supplies."

(b)Foreign End Products:

Line Item No. Country of Origin Exceeds 55% domestic content (yes/no)

(b)[List as necessary]

(c) Domestic end products containing a critical component:

Line Item No. ___

[List as necessary]

(d) The Government will evaluate offers in accordance with the policies and procedures of part 25 of the Federal Acquisition Regulation.

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE

FEB 1998

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

(End of Provision)

52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS NOV 2020

(a)The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation of any Department of Health and Human Services (48 CFR Chapter 3) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of Provision)

The following Department of Health and Human Services Acquisition Regulation provisions also apply:

☐ 352.219-70 MENTOR-PROTÉGÉ PROGRAM DEC 2015

☒ 352.223-71 INSTRUCTIONS TO OFFERORS – SUSTAINABLE ACQUISITION DEC 2015

☒ 352.226-5 NOTICE OF INDIAN ECONOMIC ENTERPRISE SET ASIDE MAR 2022

☒ 352.226-4 NOTICE OF INDIAN SMALL BUSINESS ECONOMIC ENTERPRISE SET

ASIDE

MAR 2022

☒ 352.226-7 INDIAN ECONOMIC ENTERPRISE REPRESENTATION MAR 2022

☐ 352.239-73 ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY

NOTICE

DEC 2015

Supply list:

Items Quantity Pediatric 2 LIQ 12

Specialty IA LIQ 1 13

Specialty IA LIQ 2 13

Viroclear 50

Virotrol I 50

Virotrol Hiv-1 50

Virotrol Hiv-2 50

Virotrol Hiv-1 gO 12

Shipping cost

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