Non-PSC Rheumatologist Services for the Northern Navajo Medical Center

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."
• Eligibility Period: The enterprise must meet the definition throughout the offer period, contract award, and the full contract performance period. Notification is required if eligibility is lost.
• 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 a violation of law and punishable under 18 U.S.C. 1001, with false claims subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.
• 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 any bidder seeking to participate in opportunities designated under the Buy Indian Act. Bidders must accurately complete this self-certification to demonstrate their eligibility. Failure to meet the IEE definition or provide accurate information can lead to disqualification or penalties.

Sources-Sought Notice

This notice is issued by the Indian Health Service, Shiprock Service Unit to identify capable Indian-owned, economic enterprises (large or small) that can fulfill a government requirement for Non-PSC Pediatric Rheumatologist Services for the Pediatric Department at the Northern Navajo Medical Center. This is for market research only to determine acquisition strategy, including competition, set-asides, and locating Indian-owned economic enterprises. It is not a solicitation, and responses are purely voluntary.

This notice seeks information on companies capable of providing Pediatric Rheumatologist Services.

Not applicable, as this is not a solicitation.

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

• Submission Method: Email to Cornelius Tsipai at cornelius.tsipai@ihs.gov with the subject line "SS-SRSU-26-0017".

• Required Information:

  1. Company Profile: UEI, Name, Address, Primary POC, business size, ownership type, socio-economic status (e.g., 8(a), WOSB, SDVOSB, HUBZone), Native American ownership, SAM.gov representations/certifications.
  2. Capability Statement: Brief statement relating to the government requirement, potentially including past performance and established contracts (GSA, VA Schedule).
  3. Indian-owned Small Business Economic Enterprises (ISBEEs) and Indian-owned Economic Enterprises (IEEs) must submit a completed IHS IEE Representation Form (attached).

• Evaluation: No feedback or evaluations will be provided.

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

• The North American Industry Classification System (NAICS) code is 561320 (Temporary Health Services) with a small business size standard of $34M.

• Offerors and quoters must be registered in the System for Award Management (SAM.gov).

• Telephone inquiries will not be accepted.