Attachment 5 Preference Declaration Form.docx
DOCX document 33 KB Posted
- Attached to
- 12th and 13th Floor Carpet Tile Replacement
- Solicitation number
- B27000484
- Issued by
- Honolulu County, Hawaii
About this file
This is a Preference Declaration Form related to a competitive sealed bid solicitation by the State of Hawaii Department of Human Resources Development (DHRD) for construction services involving carpet tile replacement on the 12th and 13th floors of the Leiopapa a Kamehameha (LAK) Building. The project scope involves replacing existing carpeting with modular carpet tile on two floors of the building. The form serves as a declaration mechanism for bidders to indicate their eligibility status and any applicable preferences under Hawaii Revised Statutes Chapter 103D procurement regulations.
The Preference Declaration Form enables bidders to certify their business classification and claim applicable state procurement preferences, such as local business preferences, Hawaii-based contractor preferences, or other statutory preferences available under HRS Chapter 103D. Completion and submission of this form as part of the bid package is essential for bidders to be considered for any preference advantages in the competitive evaluation process. The form requires accurate disclosure of business information to substantiate preference claims and ensure compliance with state procurement requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| State Holidays 2026 and 2027.pdf | ||
| Attachment 1 Bidder Form.docx | DOCX document | |
| Attachment 3 Carpet Tile Product Form.docx | DOCX document | |
| Attachment 7 Safety and Health Program Certification Form.docx | DOCX document | |
| IFB No. 27-02-ASO - 12th and 13th Floor Carpet Tile (2026-10-01).pdf | ||
| Attachment 2 Qualification Form.docx | DOCX document | |
| Attachment 4 Joint Contractor and Subcontractor Listing Form.docx | DOCX document | |
| AG008 103D.pdf | ||
| Attachment 6 HRS 103 55.5 Certification Form.docx | DOCX document |
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Text version
STATE OF HAWAIʻI
DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT
PREFERENCE DECLARATION FORM
DHRD IFB NO. 27-02-ASO
INSTRUCTIONS TO BIDDERS:
Review subsections 14.5, 16.5, 16.6, and 16.7 of the IFB to confirm eligibility and required submittals for evaluation preferences.
Check 'CLAIMED' or 'NOT CLAIMED' for each preference below. If claiming, you MUST complete and attach the specified verification form or certificates to your HIePRO bid package. Failure to provide matching certificates at or before the bid opening will disqualify you from the respective preference evaluation.
| Type of Evaluation Preference |
| Status Selection |
| Mandatory Documentation Required Attached to Bid |
1. Hawaiʻi Bidder Preference (HRS §103D-302(j) & HAR §3-124 Subchapter 1) Grants a 5% price evaluation reduction for qualified residents.
[ ] CLAIMED
[ ] NOT CLAIMED
Form SPO-081 (Hawaiʻi Bidder/Offeror Preference Certification Form) filled and executed.
2. Apprenticeship Agreement Preference (HRS §103-55.6 & DLIR Rules) Grants a 5% price evaluation reduction for active program participants.
[ ] CLAIMED
[ ] NOT CLAIMED
DLIR Certification Form 1 (Certification of Bidder's Participation in Approved Apprenticeship Program) for each applicable trade.
3. Taxpayer Preference (HRS §103D-1008 & HAR §3-124 Subchapter 7) Adjusts tax-exempt bids upward by the applicable retail Hawaiʻi GET rate.
[ ] CLAIMED
[ ] NOT CLAIMED
Valid Tax Clearance Certificate(s) issued by the Hawaiʻi Department of Taxation (DOTAX) and the Internal Revenue Service (IRS).
3.a. Tax Status for Evaluation Purposes ☐ The bid price includes all applicable Hawaii GET and use tax ☐ The bid price excludes applicable Hawaii GET and/or use tax because the Offeror claims exemption
Bidder Acknowledgment & Certification By signing below, the Bidder acknowledges and certifies that: (1) The preferences checked above apply strictly for evaluation purposes only; (2) the Contract, if awarded, shall be set at the Bidder's original Total Sum Bid Price, not the preference-adjusted evaluated price; and (3) For any preference that requires continuing eligibility during Contract performance, the Bidder must maintain the applicable eligibility requirements throughout Contract performance, subject to any penalties, price adjustments, or other consequences specified by applicable law.
| Legal Name of Bidding Entity: |
| ________________________________________________ |
| Authorized Officer Signature: |
| ________________________________________________ |
| Printed Name & Official Title: |
| ________________________________________________ |
| Date of Submittal & Declaration: |
| __________________________, 2026 |
| Preference Declaration Form | DHRD IFB No. 27-02-ASO |
| 2026-09-29 |
File details come from the government source that posted it. Updated .