Haskell Indian Health Center Lab Door Relocation Project

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 do or do not meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Required Information: Fields include Name of Federally Recognized Tribal Entity, Name of the 51% owner of IEE Firm, Business Name, DUNS Number, and Certifying Signature/Print Name.

This form is crucial for bidders seeking to participate in opportunities designated under the Buy Indian Act. Completing and submitting this form accurately is a requirement for self-certification of eligibility. Failure to meet these requirements or providing false information can lead to penalties. Offerors may be required to provide documentation of eligibility, and successful offerors must be registered with the System of Award Management (SAM).

Sources Sought Notice

This notice is issued by the Indian Health Service (IHS) to identify Indian Small Business Economic Enterprises (ISBEEs) capable of performing the "RELOCATE LAB DOOR AT HASKELL IHC" requirement. This is NOT a solicitation for proposals. The IHS intends to use the Buy Indian Act negotiation authority, which prioritizes Indian Economic Enterprises.

Interested parties are requested to submit a written response demonstrating their capability, experience, and ability to perform the work. Specific information required includes:

• Company Name

• Socioeconomic Status

• SAM Unique Entity Identifier (UEI)

• Company contact information (mailing address, phone, website)

• Point of contact with authority to clarify responses

• DUNS Number

• Cage Code

• Tax ID

• Date submitted

• Applicable GSA Schedule or other procurement vehicle

• SAM registration status

• Completed Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form (attached)

• Responses must be submitted via email to Noleen Powell at Noleen.Powell@ihs.gov.

• The subject line must include "246-26-Q-0007 Haskell Lab Door Relocation Project".

• The deadline for submission is December 26, 2025, no later than 5:00 PM CST.

• Capability statements are limited to a maximum of five (5) pages.

• Responses will not be returned and will not be accepted after the due date.

This notice specifically seeks ISBEEs and encourages other small businesses to respond. The IHS will use the Buy Indian Act negotiation authority.

• This notice does not obligate the Government to award a contract.
• Information provided is voluntary and will not be returned.
• No payment will be made for information submitted.
• The Government may use submitted information for future solicitations.
• Respondents should ensure their response is detailed enough for qualification assessment.
• The Government is not obligated to acknowledge receipt or provide feedback.
• A pre-solicitation synopsis and solicitation may be published based on responses.
• Responses to this notice are not adequate responses to a future solicitation.
• Do not include proprietary, classified, confidential, or sensitive information.