Sources Sought - Ak-Chin Community Health Clinic Alarm and Surveillance System

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.

• Eligibility Requirements: The enterprise must meet the definition of "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period. Offerors must notify the Contracting Officer immediately if they no longer meet these requirements.
• Representation: Offerors must indicate whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act.
• Required Information: The form requires the Offeror to provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of the IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature
  • Print Name

This form is critical for bidders seeking to participate in opportunities designated under the Buy Indian Act. It requires a self-certification of eligibility and specific business information. Failure to meet these requirements or provide accurate information can lead to disqualification or penalties. Offerors must also be registered with the System of Award Management (SAM).

Sources Sought Notice

This notice is a market research tool to determine compliance with the Buy Indian Act and to inform a potential set-aside decision for the procurement of an integrated security system for the Ak-Chin Community Health Clinic. The system will be maintained at the Phoenix Indian Medical Center and includes a remotely monitored alarm system, surveillance cameras, and associated monitoring and support services.

• Lease, installation, and maintenance of an integrated security system.

• Remotely monitored alarm system.

• Surveillance cameras.

• Associated monitoring and support services.

• The system aims to enhance security and safety of facilities, personnel, and visitors, and safeguard federally owned property.

• Not specified in this notice.

• This is NOT a Request for Quote (RFQ).

• Interested firms must respond in writing.

• Response Date/Time: April 1, 2026, 1300 Local Time.

• The government will give priority for purchases by utilizing ISBEE set-aside to the maximum extent possible, in accordance with the Buy Indian Act.

• Vendors must indicate if they qualify as an Indian Economic Enterprise (IEE) or Indian Small Business Economic Enterprise (ISBEE).

• Specific information required includes:

  • Company name
  • Point of contact details
  • FSS / SEWP Contract number (if applicable)
  • DUNS number or SAM Unique Entity Identifier
  • Tax ID number
  • Indication of business category (IEE or ISBEE)
  • Capability statement addressing qualifications and ability to provide the requirement.
  • Documentation from manufacturer verifying authorization as a distributor (See Attachment 2).
  • Representation on the IHS Indian Economic Enterprise Representation form (Attachment 1).
  • Identification of the Federally Recognized Indian Tribe or Alaska Native Corporation relied upon for IEE status.

• Gray market items (OEM goods sold through unauthorized channels) are not acceptable. Vendors must be an OEM, authorized dealer, distributor, or reseller, verified by authorization letter.

• Prospective contractors must complete electronic annual representations and certifications in SAM.

• This is the only notice; no other copies will be provided.