KHC Energy Management & Control System Service

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" 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 IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature
  • Print Name
• Legal Consequences: False or misleading information is a violation of law, punishable under 18 U.S.C. 1001, and false claims are subject to penalties under 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.
• Additional Requirements: 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 IEE definition or accurately represent the enterprise's status may result in disqualification or penalties. Contracting Officers may require further documentation to verify eligibility.

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.

• Self-Certification: Offerors must certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.
• Eligibility Period: The enterprise must meet the IEE definition at the time of offer, contract award, and throughout the contract performance period. Notification is required if eligibility is lost.
• 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 subject to penalties.
• Additional Requirements: Successful offerors must also be registered with the System of Award Management (SAM).

This form is critical for any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete and submit this form to self-certify their eligibility as an Indian Economic Enterprise. Failure to meet the definition or accurately represent status can lead to disqualification or penalties. It also highlights that contracting officers may require further documentation and that SAM registration is mandatory for successful offerors.