KHC ADA Door Opener Project

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.

• 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 period, at the time of contract award, and during the full contract performance period. Any changes in eligibility must be immediately reported.
• 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 subject to legal penalties.
• 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 bidders responding to opportunities that include the Buy Indian Act preference. Bidders must accurately complete this form to self-certify their eligibility. Failure to meet the definition or complete the form correctly could disqualify an offer. It also highlights potential requirements for documentation and SAM registration.

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

To install twenty-seven ADA door openers throughout the Kayenta Health Center (KHC) to improve accessibility.

• Modifications and/or replacements of existing doors to maintain fire/smoke ratings.

• Installation of new ADA door openers, including hardware and door replacements.

• Testing and certification of all installed hardware and door openers.

• Disposal of debris in accordance with EPA regulations.

• Ensuring existing electronic door access systems are compatible with new ADA openers.

• Replacing doors with the same or higher grade, solid core, or metal doors as the existing ones.

• All hardware and door replacements must be tested and certified (e.g., UL certified).

• Fire and smoke door installations must pass relevant inspections.

• Doors must open and close properly after installation and testing.

• The period of performance shall commence immediately upon award.

• The work will be performed at Kayenta Health Center, located south of Arizona State Highway 160 at milepost 364.3.

• Contractor must adhere to Safety and Hazard Awareness (PPE, job-specific hazards, electrical isolation).

• Compliance with NFPA criteria and The Joint Commission standards and regulations.

• Door specifications must meet government FGI, Federal Guideline Institute standards.

• Door openers must be a well-known, reliable brand.

• Work must be performed between 8:00 am and 5:00 pm, Monday through Friday, excluding Federal Holidays, unless otherwise agreed upon.

• Contractor must obtain an identification badge and check in with security daily.

• Proper demolition and construction methods are required in a health facility environment to minimize contamination.

• HVAC vents, exhaust hoods, and openings must be covered and sealed.

• Fire safety systems (sprinklers, smoke alarms) must be protected.

• A one-year workmanship warranty is required.