Reverse Osmosis Equipment Preventive Maintenance and Service

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" as required by the Buy Indian Act (25 U.S.C. 47) and HHSAR 326.601.

• 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 submission, contract award, and full contract performance period.
• Notification Requirement: Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements.
• Documentation: Contracting Officers may require documentation of eligibility.
• 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: 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 and submit this form to self-certify their eligibility as an "Indian Economic Enterprise." Failure to meet the criteria or accurately complete the form may disqualify the offer.

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

To provide annual preventive maintenance, repairs, parts replacement, labor, and travel for a reverse-osmosis (RO) water treatment system used in Central Sterile Reprocessing at the Whiteriver Service Unit (WRSU) in Whiteriver, Arizona.

• Provide full service for one RO water treatment system.

• Ensure all preventative maintenance is performed on schedule.

• Repair or replace all components to meet Original Equipment Manufacturer (OEM) specifications.

• Provide supervision, labor, parts, materials, tools, supplies, maintenance, calibration, ground transportation, and equipment service.

• Warrant all services performed and ensure units remain defect-free for 30 days post-acceptance.

• Services must conform to OEM specifications, NFPA 99 and 101, The Joint Commission standards, and relevant Federal, Tribal, State, and local regulatory guidance.

• Contractor must comply with HIPAA security requirements.

• Contractor shall submit legible field service and test reports within 15 calendar days after completion of service or repair work.

• Location: Whiteriver Indian Health Service Hospital, 200 West Hospital Drive, Whiteriver, Arizona 85941.

• Work to be performed during normal business hours (Monday-Friday, 8:00 a.m. to 5:00 p.m.), excluding federal holidays.

• Contractor must be authorized by the manufacturer to perform all work.

• Contractor must obtain and maintain all required manufacturer, Federal, State, and local licenses and certifications.

• Technicians must have valid documentation of training and current manufacturer authorization (to be submitted with offer).

• Contractor must have ready access to new OEM parts; all replaced parts must be new OEM.

• Contractor personnel must report to Human Resources and comply with IHS visitation policies, obtaining a "Guest" ID badge.

• Contractor must provide a detailed schedule for POC approval prior to work commencement.

• Contractor must notify the POC before starting and upon completion of services.

• Equipment serviced must be labeled upon completion with service details.

• All shipments of materials/supplies to the project site are addressed to the Contractor, not IHS.

• Contractor-supplied checklist and technician qualifications/authorization are due within seven (7) calendar days after notice of award.

• Service and repair reports are due within fifteen (15) calendar days from the performance date.