Attachment 1-Offeror Qualification Form.pdf
PDF 586 KB Posted
- Attached to
- IT End-User Help Desk and Support Services
- Solicitation number
- B27000013
- Issued by
- Hawaii
About this file
This is an Offeror's Qualification Form for a state and local contract opportunity with the State of Hawaii. The form is designed to collect essential information from contractors bidding on IFB-430-27-01, which involves providing counseling and coordination of chaplaincy services. However, there is a notable discrepancy between the form's stated scope of work and the related contract opportunity description, which indicates the position is actually for IT end-user help desk and support services to the Adult Mental Health Division and Hawaii State Hospital.
The qualification form requires offerors to provide their exact legal name, business address, contact information, and details of any subcontractors involved in the proposal. Additionally, offerors must submit a statement of experience and qualifications demonstrating their capability to perform the required services. The form requires applicants to provide at least three professional references from clients for whom they have performed pharmacy billing audit services within the past five years, including firm name, address, contact person, telephone number, and email address. This reference requirement further indicates inconsistencies within the documentation, as pharmacy billing audit services do not align with either chaplaincy services or IT help desk support, suggesting potential errors in the form's preparation or assembly.
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Text version
OFFEROR’S QUALIFICATION FORM
Please complete this form as fully and explicitly as possible to facilitate evaluation of your firm. Use additional sheets and substantiating documents when necessary.
A. Exact Legal Name of Contractor: ___________________________________________
Street Address
City State Zip Code
Contact Person Name: _________________________ Cell No. ___________________
Telephone No.: _______________________________ Fax No.: __________________
E-mail Address: _______________________________
Subcontractor Name, if applicable: _____________________________________________
Street Address
City State Zip Code
Contact Person Name: _________________________ Cell No. ___________________
Telephone No.: _______________________________ Fax No.: __________________
E-mail Address: _______________________________
B. Statement of Experience and Qualifications:
PROVIDE COUNSELING AND COORDINATION
OF CHAPLAINCY SERVICES
IFB-430-27-01
C. References:
Offerer shall list at least three references for whom the offerer has performed pharmacy biling audit within the past 5 years.
1. Name of Firm
Address:
Contact Person
Telephone
2. Name of Firm
Address:
Contact Person
Telephone
3. Name of Firm
Address:
Contact Person
Telephone
File details come from the government source that posted it. Updated .