Telemedicine Emergency and Sexual Assault Forensic Support Services Support for Five (5) Facilities within the Great Plains Area Indian Health Service (GPAIHS)

This document is an Indian Health Service (IHS) Buy Indian Act Indian Economic Enterprise (IEE) Representation Form. It serves as a self-certification mechanism for vendors seeking to qualify for set-aside or sole-source contracts under the Buy Indian Act (25 U.S.C. 47) for the Telemedicine Emergency & Sexual Assault Forensic Support Service solicitation (IHS-SS-26-1527014), dated July 9, 2026. To qualify, an offeror must self-certify that it meets the definition of an IEE at three critical stages: when submitting an offer, at the time of contract award, and throughout the entire period of contract performance. Contractors must immediately notify the Contracting Officer in writing if they lose eligibility. Additionally, qualifying firms must be registered in the System for Award Management (SAM) and may be required to submit supporting documentation of their eligibility. The form warns that submitting false or misleading information to secure a set-aside award violates federal law and is punishable under 18 U.S.C. 1001, with false claims during performance subject to civil and criminal penalties. To complete the representation, the offeror must indicate whether it meets the IEE definition and provide the name of the 51% owner, a certifying signature, the name of the federally recognized tribal entity, the business name, and its DUNS number.