SSN - Denture Teeth for Kayenta Health Center Dental Department

The Indian Health Service (IHS) Buy Indian Act Representation Form is a mandatory self-certification document for offerors responding to solicitations, sources sought, or RFIs under the Buy Indian Act (25 U.S.C. 47). This form requires offerors to affirm their status as an “Indian Economic Enterprise” (IEE) as defined by HHSAR 326.601, ensuring compliance at the time of offer, contract award, and throughout the contract performance period. Contractors must immediately notify the Contracting Officer if they no longer meet eligibility requirements. Eligibility documentation may be requested, and awards are subject to protest. Successful offerors must also be registered with the System for Award Management (SAM). The document warns against submitting false or misleading information, citing penalties under 18 U.S.C. 1001 for false statements and 31 U.S.C. 3729-3731 and 18 U.S.C. 287 for false claims. The form includes spaces for the enterprise to declare whether it meets the IEE definition, and requires the name of the 51% owner, certifying signature, print name, name of Federally Recognized Tribal Entity, business name, and DUNS Number.