Hopi Health Care Center Propane Service

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 a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Eligibility Requirements: The enterprise must meet the definition of "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period.
• Notification: Contractors must immediately notify the Contracting Officer in writing 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 a violation of law and subject to penalties.
• Representation Section: Requires the offeror to indicate whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Information Fields: Includes spaces for "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 bidders responding to opportunities that have a Buy Indian Act preference or set-aside. Bidders must accurately complete this form to self-certify their eligibility. Failure to meet the definition or properly complete the form could disqualify an offer. It also highlights the need for SAM registration and potential documentation requirements.

Sources Sought Notice

This notice is for market research purposes only and is not a Request for Quote (RFQ). The Indian Health Service (IHS) is seeking information to determine compliance with the Buy Indian Act and to decide on a potential set-aside for Indian Small Business Economic Enterprises (ISBEEs). The IHS Contracting Officer will prioritize purchases for ISBEEs for supplies, services, or construction subject to commercial items or Simplified Acquisition Procedures.

Delivery of propane to the Hopi Health Care Center (HHCC) located off Highway 264, MP 388 in Polacca, Arizona, and the IHS Employee Housing Compound Units located off Highway 264, MP 402 in Keams Canyon, Arizona.

• Indian Economic Enterprise (IEE): A business owned by one or more Indians, Federally Recognized Indian Tribes, or Alaska Native Corporations, with at least 51% Indian ownership, at least 51% of earnings going to these entities, and controlled by one or more Indians.
• Indian Small Business Economic Enterprise (ISBEE): An IEE that also qualifies as a small business concern per 13 CFR Part 121.

Interested firms must respond in writing and include:

• Company name

• Point of contact (name, title, phone, email)

• FSS / SEWP Contract number (if applicable)

• DUNS number or SAM Unique Entity Identifier

• Tax ID number

• Indication of business category (IEE or ISBEE)

• A capability statement addressing qualifications and ability to meet the requirement.

• Submit the designated IHS Indian Economic Enterprise Representation form (attached).

• Identify the Federally Recognized Indian Tribe or Alaska Native Corporation relied upon for IEE status.

• Firms must be registered in the System for Award Management (SAM).

• This is the only notice; no other copies will be provided.

• The response date is January 22, 2026, 1300 Local Time.

• Attachment 1: IHS Indian Economic Enterprise Representation form.