PMA Maintenance Agreement for Network Server

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It requires offerors to self-certify their status as an "Indian Economic Enterprise" in accordance with 25 U.S.C. 47 and HHSAR 326.601. This certification is necessary for responding to solicitations, requests for information (RFIs), or potential contracts under the Buy Indian Act.

• Self-Certification: Offerors must attest whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Eligibility Period: The enterprise must meet the definition throughout the offer period, at the time of contract award, and during the full contract performance period. Any change in eligibility requires immediate notification to the Contracting Officer.
• Required Information: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of the IEE Firm
  • Business Name
  • Unique Entity Identifier (UEI) Number
  • Certifying Signature and Print Name
• Consequences of False Information: Submitting false or misleading information is a violation of law and punishable under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731, 18 U.S.C. 287.

This form is critical for any bidder seeking to qualify for contracts or set-asides under the Buy Indian Act. Bidders must accurately complete this self-certification to demonstrate their eligibility. Failure to meet the definition or provide accurate information can lead to disqualification or penalties. Offerors may also need to provide supporting documentation upon request and must be registered in the System of Award Management (SAM).

Statement of Work (SOW) / Performance Work Statement (PWS)

This Scope of Work (SOW) outlines the requirements for a full maintenance agreement for the network server at the Chinle Comprehensive Health Care Facility, which handles subscriber and dependent coverage for claims status, submission of 837 claims for Medicare and Private insurance payers, and inquiry/correction of pending claims.

• Provide Full Preventive Maintenance services for the existing Internet Server used for 837 claims processing.

• Maintain full network services for the delivery of IT services to the Chinle Comprehensive Health Care Facility (CCHCF).

• Provide training to CCHCF users.

• Limit downtime to ensure continuous operations.

• Monthly service will be provided.

• Downtime is to be limited.

• Place of Performance: Chinle Comprehensive Health Care Facility, Chinle, Arizona.

• Period of Performance: 6-months from the date of award, with flexibility for intermittent support.

• Invoices to be submitted monthly from March 01, 2026, to August 31, 2026.

• Contractor must possess basic knowledge, skills, and abilities to maintain and provide network services.

• Contractor must be in full compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

• Contractor shall define license and all relative documents.

• Contractor will comply with the Privacy Act and CFR 42 Part 2 regarding patient records.

• The Government may terminate the contract with at least 15 days' written notice.