KHC Radiology Batteries – Removal and Replacement

Form / Attachment / Pricing Sheet

This document is the Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form. It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" as defined by the Buy Indian Act and HHSAR 326.601. This form is required in response to Sources Sought Notices, Requests for Information (RFIs), or Solicitations.

• Eligibility Requirements: The enterprise must meet the IEE definition at the time of offer, contract award, and throughout the contract performance period. Any change in eligibility must be reported immediately to the Contracting Officer.
• Documentation: Contracting Officers may request documentation of eligibility before awarding Buy Indian Act contracts. Awards may be subject to protest if eligibility is questioned.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Penalties: Submission of false or misleading information is a violation of law, punishable under 18 U.S.C. 1001, and false claims are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
• Representation Section: Bidders must indicate whether they represent that their offer does or does not meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Required Fields: Name of Federally Recognized Tribal Entity, Name of the 51% owner of IEE Firm, Business Name, DUNS Number, Certifying Signature, and Print Name.

This form is critical for any bidder seeking to qualify for contracts under the Buy Indian Act. Bidders must accurately complete this self-certification to demonstrate their eligibility. Failure to meet the IEE definition or provide accurate information can lead to disqualification or penalties. It also highlights the need for SAM registration and potential documentation requests.

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" as required by the Buy Indian Act. This form is to be submitted in response to Sources Sought Notices, Requests for Information (RFIs), or Solicitations.

• Self-Certification: Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Eligibility Period: The enterprise must meet the definition throughout the offer, award, and contract performance periods.
• Notification Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Documentation: Contracting Officers may require documentation of eligibility, and awards may be subject to protest.
• Registration: Successful offerors must be registered with the System of Award Management (SAM).
• Penalties: False or misleading information is punishable under federal law.
• Required Fields: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature
  • Print Name

This form is critical for any bidder seeking to participate in opportunities designated for "Indian Economic Enterprises" under the Buy Indian Act. Bidders must accurately complete this self-certification to demonstrate their eligibility. Failure to meet the criteria or complete the form correctly could disqualify an offer.