KHC Security Guard Shack Modifications

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 definition throughout the solicitation response, contract award, and the full contract performance period. Notification is required if eligibility is lost.
• Required Information: Fields include:
  • Name of Federally Recognized Tribal Entity
  • 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 31 U.S.C. 3729-3731.
• 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 for or influenced by the Buy Indian Act. Bidders must accurately complete this self-certification to demonstrate their eligibility. Failure to meet the IEE definition or accurately represent the business's status can lead to disqualification or penalties. Contracting Officers may require further documentation to verify eligibility.

Statement of Work (SOW)

To replace the existing guard shack at Kayenta Health Center (KHC) with a bulletproof security guard booth and install crash-resistant steel bollards.

• Furnish and install a 6'x10' bulletproof security guard booth with Level 3 ballistic proof glass, windows, door, and panels.

• Remove the existing Guardian booth.

• Ensure the new booth has a main electrical disconnect and reconnect electrical power.

• Furnish and install eight crash-resistant steel bollards around the booth, dug to a 3-foot depth or to ASTM standards.

• Bollards must be capable of stopping a 5000 lb. vehicle at 30 mph (M30) and must be removable.

• Furnish all necessary supplies and materials.

• Work must adhere to best common practices and standards, including Safety and Hazard Awareness, NFPA, NEC, and ASTM F2656.

• Submittals for building and bollard specifications are required.

• Work area must be kept clean and free of debris.

• Finished work must be professional and functional.

• Period of performance begins immediately upon award.

• Work is to be performed at Kayenta Health Center, located south of Arizona State Highway 160 at milepost 364.3.

• Minimize contamination in a health facility environment during demolition and construction.

• Contractors must obtain an ID badge before starting work (process may take up to 3 hours).

• Wear ID badge on premises and check in with security daily.

• Abide by any latest COVID-19 requirements.

• Work hours are typically Monday-Friday, 8:00 am - 5:00 pm, excluding Federal Holidays, but may require discussion and agreement for weekend or afterhours work.

• A schedule of agreed-upon dates must be provided at least two weeks in advance.

• Any foreseen costs, work hours, or changes affecting KSU costs must be brought to the KHC project representative's attention.

• Maintain uninterrupted normal business and patient care activities.

• One-year workmanship warranty.

• Equipment warranty provided by the manufacturer, with finish certificates.