Non-PSC Pharmacist Services for the Northern Navajo Medical Center

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 an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period. Any changes in eligibility must be immediately reported to the Contracting Officer.
• Documentation: Contracting Officers may require documentation of eligibility before awarding Buy Indian Act contracts.
• Registration: Successful Offerors must be registered with the System of Award Management (SAM).
• Penalties: False or misleading information is a violation of law and punishable under 18 U.S.C. 1001 and 31 U.S.C. 3729-3731.
• Representation Section: Bidders must indicate whether they represent that their offer meets the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Required Fields: 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 any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete this form to self-certify their eligibility. Failure to meet the criteria or complete the form correctly could disqualify an offer. It also highlights potential requirements for documentation and SAM registration.

Sources-Sought Notice

This notice is issued by the Indian Health Service, Shiprock Service Unit to identify capable Indian-owned, economic enterprises (IEE) – large or small (ISBEE) – that can fulfill a government requirement for Non-PSC Pharmacist Services for the Pharmacy Department at the Northern Navajo Medical Center. Other capable firms are also invited to respond.

• This is NOT a Solicitation. The information gathered is for market research to determine acquisition strategy, including competition, set-asides, and identifying Indian-owned economic enterprises.

• Submission of information is voluntary, and the government assumes no financial responsibility for costs incurred.

• Offerors and quoters must be registered in the System for Award Management (SAM.gov) at the time of submission and award.

• Deadline: Friday, March 20, 2026, at 12:00 PM MDT.

• To: Cornelius Tsipai, Contract Specialist at cornelius.tsipai@ihs.gov

• Subject Line: "SS-SRSU-26-0015"

1. Company Profile: UEI, Name and Address, Primary POC information, business size and ownership type, socio-economic status (e.g., 8(a), WOSB, SDVOSB, HUBZone), Native American ownership identification, SAM.gov representations and certifications, and other relevant documentation.
2. Capability Statement: A brief statement relating to the described government requirement. May include current/past performance history or established contracts (e.g., GSA, VA Schedule).
3. For ISBEEs and IEEs: A completed IHS IEE Representation Form (attached) in accordance with HHSAR 326.606-1(b).

• Telephone inquiries will not be accepted or acknowledged.

• No feedback or evaluations will be provided on submissions.

• 561320 Temporary Health Services, with a small business size standard of $34M.

• Responses may be considered for Buy Indian Act opportunities first, then for set-aside programs under the Small Business Act.