Sources Sought - Whiteriver Service Unit Negative Pressure Would Therapy Equipment Rental

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 an "Indian Economic Enterprise" at the time of offer, contract award, and throughout the contract performance period. Any changes in eligibility must be immediately reported.
• Representation: Offerors must indicate whether they do or do not meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• 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
• Legal Consequences: False or misleading information is a violation of law and subject to penalties.

This form is critical for bidders responding to opportunities that are set aside or sole-source under the Buy Indian Act. Bidders must accurately complete and submit this form to certify their eligibility. Failure to meet these requirements or provide accurate information can lead to disqualification or penalties. Offerors may also need to be registered in the System of Award Management (SAM).

Sources Sought Notice

This notice is for market research purposes only 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). It is not a Request for Quote (RFQ) or a solicitation.

• The government is seeking information regarding the provision of Negative Pressure Wound Therapy (NPWT) Equipment Rental Services to the Inpatient department at the Whiteriver Service Unit.

• Not applicable, as this is a sources sought notice.

• Interested firms must respond in writing and include:

  • Company name
  • Point of contact information
  • 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 addressing qualifications and ability to provide the requirement.
  • Documentation from the manufacturer if the firm is an authorized distributor (see Attachment 2).

• Responses must be made on the designated IHS Indian Economic Enterprise Representation form.

• Offerors must be registered in the System for Award Management (SAM).

• The government will give priority for purchases to IEEs/ISBEEs under the Buy Indian Act.

• The acquisition may be set-aside exclusively for ISBEEs.

• This is a market research tool to identify potential sources and determine if a set-aside is appropriate.

• No offers or quotations will be accepted at this time.

• The response deadline is 06/22/2026, 1300 Local Time.

• Gray market items (goods sold through unauthorized channels) and remanufactured items will not be acceptable. Vendors must be an OEM, authorized dealer, distributor, or reseller, verified by the OEM.