Clinical Laboratory Test Services

Form / Attachment / Pricing Sheet

This document is the "Indian Economic Enterprise Representation Form" for the "Buy Indian Act." 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 Criteria: Offerors must meet the definition of an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period.
• Notification Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Documentation: Contracting Officers may require documentation of eligibility.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Representation Section: Requires the offeror to represent whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Fields to Complete: 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 intending to claim eligibility under the Buy Indian Act for the "Clinical Laboratory Testing Services" opportunity (Solicitation/Sources Sought/RFI #: IHS1523615). Bidders must accurately complete this form to self-certify their status as an "Indian Economic Enterprise" to be considered for awards under this authority. Failure to meet these requirements or provide false information can lead to penalties and ineligibility.

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

To provide clinical laboratory patient testing services for the Wagner IHS Healthcare Facility for tests not performed on-site. The goal is to decrease turnaround times for communicable disease testing, enabling faster notification and tracking of individuals, and potentially reducing disease transmission.

• Provide clinical laboratory services for specimens sent via courier from the Wagner IHS Healthcare Facility.

• Services include, but are not limited to, testing for blood lead, chlamydia, gonorrhea, and HIV.

• Ensure accurate testing on all received specimens in a timely manner based on specific test requests.

• Report required diseases to the South Dakota Department of Health in accordance with SD Codified Law and Administrative Rules.

• The State Department of Health laboratory will provide hard copies of test results using the best time and cost-efficient means.

• Reports for commonly ordered tests will be provided to the requesting laboratory.

• Reports will include laboratory name and director, patient name, patient identification number, specimen collection date/time, specimen receipt date/time, and result reporting date.

• Reports will be chart-ready, include age and sex reference ranges, and consolidate all test results for a patient on a single report form for a given day.

• Period of Performance: June 1, 2026, to May 31, 2027.

• Place of Performance: Off-site laboratory (not on-site at the Wagner IHS Healthcare Facility).

• Contractor must provide mailers, shipping containers, and any other special requirements for specimen transfer.

• Contractor must meet all current accreditation requirements.

• Contractor must abide by HIPAA standards and the privacy act.

• The Contractor is solely responsible for all federal and state taxes, unemployment insurance, social security, and worker's compensation.

• Invoices must be submitted electronically via the Department of Treasury Invoice Processing Platform (IPP) unless alternate procedures are authorized in writing by the Contracting Officer.