SS Attachment 3 IHS IEE Representation Form.pdf
PDF 3 MB Posted
- Attached to
- HHC Qtrs Construction Federal contract opportunity
- Solicitation number
- SS75H70123R00040
About this file
This document contains an Indian Economic Enterprise Representation Form and details of a related federal contract opportunity for construction services. The Representation Form is to be completed by offerors in response to sources sought notices, requests for information, or solicitations from the Indian Health Service to identify their status as an Indian Economic Enterprise under the Buy Indian Act. Offerors must self-certify that they meet the definition of an Indian Economic Enterprise at the time of offer, award, and throughout contract performance. Successful offerors must also be registered in the System for Award Management. The related federal contract opportunity is a Sources Sought notice from the Indian Health Service to identify potential vendors capable of performing construction of quarters at Polacca, Arizona. Responses from interested vendors will help the agency determine whether to proceed with a competitive procurement or set-aside.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| SS Attachment 1d - Hopi QTRS FF-E Specification Sheets.pdf | ||
| SS Attachment 1e - Hopi Quarters FFE BOD Cut Sheets.pdf | ||
| SS Attachment 1b - Hopi Quarters Specifications.pdf | ||
| SS Attachment 1f - Jensen - Control Panel Sequence of Operation.pdf | ||
| SS SOW HHCC Quarters Construction.pdf | ||
| SS Attachment 4 Sources Sought IEE Self-Performance Worksheet.docx | DOCX document | |
| SS Attachment 1c Hopi Quarters 100-percent FFE List.pdf | ||
| SS Attachment 1a - Hopi Quarters_FINAL CD.pdf | ||
| SS Attachment 2 NEPA HHCC Quarters.pdf | ||
| A10 Sources Sought HHC Qtrs Construction.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: SS75H70123R00040 |
| PROJECT_TITLE: Sources Sought for HHC Quarters Construction, Polacca, AZ 86042 |
| DoesNot: 0 |
| Does: Off |
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