KHC Monthly Elevator Inspection 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 defined by the Buy Indian Act (25 U.S.C. 47 and HHSAR 326.601). 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" at the time of offer, contract award, and throughout the contract performance period. Any change in eligibility requires immediate notification to the Contracting Officer.
• Representation: Offerors must indicate whether they do or do not 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 IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature and Print Name

This form is crucial for bidders seeking to participate in opportunities designated under the Buy Indian Act. It requires self-certification of eligibility and must be completed accurately. Failure to meet the definition or providing false information can lead to penalties and disqualification. Bidders should ensure they meet the criteria before completing and submitting this form. It also notes that successful offerors must be registered with the System of Award Management (SAM).

Solicitation / RFP / RFQ

This is a full and open (unrestricted) solicitation for monthly Safety Elevator Inspection Services for the Kayenta Health Center in Kayenta, Arizona. The services are required for the entire year.

• Monthly Safety Elevator Inspection Services, including Arizona State Annual Elevator Inspections.

• System and Service Review (annual formal review with KSU staff).

• Technical support for maintenance, on-call service, and repair of elevators.

• Remote monitoring for elevator emergency calls (24/7).

• Software maintenance for elevator systems.

• Telephone support for operational problems.

• On-line assistance for troubleshooting.

• System and Service Log maintenance.

• Documentation of materials used, hours spent, and service visits.

• Operator Training (one on-site annual session).

• Elevator telephone service (24/7 call response).

• Compliance with NFPA/ASME regulations and other safety entities.

• Service to two elevators: one servicing three levels, the other servicing two levels (Traction Ecospace Elevators with KCM831 Controls).

• Period of Performance: Base Year (06/01/2026 to 05/31/2027) with four (4) Option Years.

• Contract type is not explicitly stated but implied to be a commercial item contract.

• Proposals are due by 03/27/2026 at 1200 MDT.

• Evaluation factors include: Cost/Price, Technical Capability, Personnel Qualifications, and Past Performance.

• Submission instructions will be detailed in the solicitation.

• This acquisition is unrestricted.

• The contract is subject to the electronic payment process via www.ipp.gov.

• Attachment A: Statement of Work

• Attachment B: Wage Determination

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 Criteria: The enterprise must meet the definition of an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period. Offerors must notify the Contracting Officer if they no longer meet these requirements.
• Representation: Offerors must indicate whether they do or do not 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 and Print Name
• Legal Consequences: False or misleading information is a violation of law and punishable under 18 U.S.C. 1001. False claims during contract performance are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
• Additional Requirements: Individual Contracting Officers may require documentation of eligibility, and awards may be subject to protest. Successful Offerors must also be registered with the System of Award Management (SAM).

This form is critical for any bidder seeking to be considered for opportunities designated under the Buy Indian Act. Bidders must accurately complete and submit this form to self-certify their eligibility. Failure to meet the criteria or accurately represent their status can lead to disqualification or penalties.