PIMC Laparoscopic PM

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.

• 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. Any changes in eligibility must be immediately reported.
• 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 subject to 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

Bidders must complete and submit this form to self-certify their status as an Indian Economic Enterprise. Failure to meet the eligibility requirements or provide accurate information can impact their ability to be considered for or awarded contracts under the Buy Indian Act. This form is crucial for demonstrating compliance with specific set-aside requirements related to the Buy Indian Act.

Sources Sought Notice

This notice is a Sources Sought, not a Request for Quote. Its purpose is to conduct market research to determine compliance with the Buy Indian Act and to assess the feasibility of a set-aside for Indian Economic Enterprises (IEE) or Indian Small Business Economic Enterprises (ISBEE).

The contract will involve the lease of laparoscopic, bariatric, and backup instruments, as well as the inspection and repair of surgical instruments for the Phoenix Indian Medical Center (PIMC) in Phoenix, Arizona.

The Contracting Officer will prioritize purchases using the Buy Indian Act, utilizing ISBEE set-asides where possible for acquisitions of supplies, services, or construction subject to commercial items or Simplified Acquisition Procedures.

• Indian Economic Enterprise (IEE): A business owned by one or more Indians, Federally Recognized Indian Tribes, or Alaska Native Corporations, with at least 51% Indian ownership, 51% earnings derived from the contract, and controlled by one or more Indians.
• Indian Small Business Economic Enterprise (ISBEE): An IEE that also meets the criteria for a small business concern per 13 CFR Part 121.

Interested firms must respond in writing and include:

• Company name
• Point of contact (name, title, phone, email)
• FSS / SEWP Contract number (if applicable)
• DUNS number or SAM Unique Entity Identifier
• Tax ID number
• Indication of business category (IEE or ISBEE)
• A capability statement detailing qualifications for the requirement.

To support IEE/ISBEE identification and prevent circumvention of the Buy Indian Act, vendors must:

• Complete the designated IHS Indian Economic Enterprise Representation form (attached) for self-certification.
• Identify the Federally Recognized Indian Tribe or Alaska Native Corporation relied upon for IEE status.

Prospective contractors must be registered in the System for Award Management (SAM) and complete electronic annual representations and certifications as per FAR 4.12 and FAR 4.1102.

04/17/2026, 1300 Local Time.

This is the only notice; no other copies will be provided. The government will use responses to inform acquisition decisions.