NPSC Pediatrics Physician – Developmental Specialty Services for the NNMC

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, at contract award, and during 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 subject to legal penalties.
• Required Fields:
  • 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 form to self-certify their eligibility as an Indian Economic Enterprise. Failure to meet the definition or properly complete the form could disqualify an offer.

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 Pediatrics Physician – Developmental Specialty Services for the Pediatric Department at the Northern Navajo Medical Center. The Contracting Officer will consider responses for Buy Indian Act opportunities first, then for set-aside programs under the Small Business Act.

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

THIS IS NOT A SOLICITATION. Information collected is for market research only to determine acquisition strategy, including competition, set-asides, and locating Indian-owned economic enterprises. Submission 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: Wednesday, April 27, 2026, at 12:00pm MDT.
• To: Cornelius Tsipai, Contract Specialist at cornelius.tsipai@ihs.gov
• Subject Line: "SS-SRSU-26-0023"

1. Company Profile: UEI, Name and Address, Primary POC, business size and ownership type, socio-economic status (e.g., 8(a), WOSB, EDWOSB, SDVOSB, HUBZone), Native American ownership identification, SAM.gov representations and certifications.
2. Capability Statement: A brief statement of capability related to the requirement. May include past performance and established contracts (e.g., GSA, VA Schedule).
3. Indian-owned Enterprises: Indian-owned Small Business Economic Enterprises (ISBEEs) and Indian-owned Economic Enterprises (IEEs) must submit a completed IHS IEE Representation Form (attached) per HHSAR 326.606-1(b).

Telephone inquiries will not be accepted or acknowledged. No feedback or evaluations will be provided.