Annual Fire Alarm Inspections and Quarterly Fire Sprinkler Inspections

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 required by the Buy Indian Act. This form is to be submitted in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Eligibility Requirements: The enterprise must meet the definition of an "Indian Economic Enterprise" throughout the offer period, contract award, and the full contract performance period. Notification is required if eligibility is lost.
• Representation: Offerors must indicate whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.
• 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
  • DUNS Number
  • Certifying Signature
  • Print Name

This form is critical for any bidder seeking to be considered for contracts under the Buy Indian Act, particularly those that may be set-aside or sole-source. Bidders must accurately complete and submit this form to self-certify their eligibility. Failure to meet these requirements or providing false information can lead to disqualification and penalties. Contracting Officers may require further documentation of eligibility, and successful offerors must be registered in the System for Award Management (SAM).

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

To provide annual fire alarm inspections and quarterly fire sprinkler inspections for the Fort Duchesne IHS Indian Health Clinic and its associated wellness center, ensuring compliance with AAAHC and NFPA requirements.

• Conduct annual inspections of the fire alarm panel.

• Conduct quarterly inspections of the fire sprinkler systems.

• Test all fire alarm system devices and report findings.

• Test all fire sprinkler system devices and report findings.

• Provide a list of deficient devices and failed items after each inspection.

• Coordinate inspection scheduling with the facility manager.

• Inspections must adhere to AAAHC and NFPA requirements.

• A list of deficient devices and failed items must be provided post-inspection.

• Location: Fort Duchesne IHS Indian Health Clinic, 6932 E. 1400 S., Fort Duchesne, UT 84026.

• Performance is estimated to occur between specified dates (not detailed in provided text).

• Deliverables with Bid: Proposed work plan, cost schedule, Utah state licenses for fire system personnel, and proof of at least 5 years of fire system experience.

• Deliverables After Award: One Annual Fire Alarm Inspection Report, Four Quarterly Fire Inspection Reports.

• Invoicing: Submit invoices electronically with specific details (date, number, contract number, line items, service dates) to Finance and Service Unit Representatives.

• Taxes: The Department of Health and Human Services is tax-exempt in Arizona.

• TERO Requirements: The successful firm must obtain a Tribal Business Permit and submit a Compliance Plan under the Tribe’s Tribal Employment Rights Office (TERO), giving preference to qualified Tribal members in employment and business activities. Contact the Tribal Office of Revenue Commission for details.