PM Service Automatic Doors GIMC

Form / Attachment / Pricing Sheet

This document is the Indian Health Service (IHS) 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" (IEE) as defined by HHSAR 326.601, in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Eligibility Period: Offerors must meet the IEE definition at the time of offer, contract award, and throughout the contract performance period. Any change in eligibility requires immediate notification to the Contracting Officer.
• Representation: Bidders must indicate whether they represent that they do or do not meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.
• Required Information: The form requires the name of the 51% owner of the IEE firm, the name of the Federally Recognized Tribal Entity (if applicable), the Business Name, UEI Number, Certifying Signature, and Print Name.
• Legal Consequences: False or misleading information is a violation of law, punishable under 18 U.S.C. 1001, and false claims are subject to penalties under 31 U.S.C. 3729-3731 and 18 U.S.C. 287.

This form is critical for any bidder seeking to be considered for contracts or awards under the Buy Indian Act, particularly those that may be set-aside or sole-source. Bidders must accurately complete this self-certification to demonstrate their eligibility. The Contracting Officer may require further documentation, and successful offerors must be registered in the System of Award Management (SAM).

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide preventative maintenance and call-back services for automatic door assemblies at the Gallup Indian Medical Center (GIMC).

• Perform preventative maintenance (PM) and corrective maintenance for automatic doors.

• Services include labor, parts, materials, equipment, and supervision.

• Tasks include inventory, initial inspection, cleaning, lubrication, electrical/mechanical checks, and testing of door components.

• Specific PM checklist items include checking door alignment, rollers, motors, floor mats, photocells, belts, wiring, and limit switches.

• Provide Unscheduled Maintenance/Call-Back Service for operational problems.

• Maximum physical response time for on-site service is two (2) hours from GIMC call.

• Field technician must be ready to begin work within four (4) hours.

• Adherence to specified codes and standards (ANSI/BHMA, ADA, ABAAS, NFPA 101, VHA standards, etc.).

• Contractor must supply all worksite safety equipment and practices.

• Contractor is liable for any damages caused.

• Contractor must comply with Gallup Service Unit facility policies and mandatory influenza policy.

• Government reserves the right to inspect all aspects of work.

• Acceptance based on complete test and inspection of all automatic door assemblies.

• The contract period is one (1) base year with four (4) one-year option periods.

• Scheduled services: Monday through Friday, 8 AM - 5 PM (excluding Federal holidays).

• Unscheduled call-backs: 7 days a week, 24 hours a day.

• Services are for automatic doors at Gallup Indian Medical Center (GIMC) buildings.

• Contractor must submit an inventory plan electronically using MS Excel.

• Contractor must provide influenza (flu) shots for personnel and documentation.

• Contractor personnel must sign in/out at security and be accompanied by GIMC maintenance personnel.

• Documentation required includes test and inspection reports, and failure reports with cost estimates.

• Contractor shall not fragment work and must complete scheduled work without interruption.

• Contractor will invoice on a Quarterly basis, approved by COR.

• COR (Contract Officer Representative) and Local POC: Ben Williams, Maintenance Mechanic Supervisor, Gallup Indian Medical Center.