Attachment 6 HRS 103 55.5 Certification 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 wage compliance certification form issued by the State of Hawaii Department of Human Resources Development (DHRD) for Invitation for Bid (IFB) No. 27-02-ASO, which pertains to carpet tile replacement services on the 12th and 13th floors of the Leiopapa a Kamehameha Building. The project involves replacing existing carpeting with modular carpet tile and is subject to Hawaii Revised Statutes Chapter 103D competitive sealed bidding requirements. Bidders must complete and submit this certification form prior to contract award; failure to submit renders the bid non-responsive. The form requires bidders to provide company profile information including legal business name, Hawaii contractor license number with C-7 classification, authorized contact details, and authorized signatory information.
The certification form mandates that all bidders comply with HRS Chapter 104 prevailing wage requirements for all laborers and mechanics performing carpet laying, flooring work, and related installation services on the jobsite. Bidders must certify compliance with wage rates established by the Director of Labor and Industrial Relations, maintain proper payroll recordkeeping, post applicable wage rate schedules at the jobsite, and submit certified weekly payrolls to the State Contract Administrator. Bidders hold sole contractual responsibility for ensuring all subcontractors maintain valid licenses and comply with prevailing wage thresholds. The State retains the right to inspect records, interview personnel, and withhold invoice payments to satisfy any proven wage shortfalls or underpayments. The form requires execution by an authorized representative under penalty of law, with signature, date, printed name, title, and legal business entity name as submitted in the HIePRO system.
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Other files
| File | Type | Posted |
|---|---|---|
| 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 5 Preference Declaration Form.docx | DOCX document | |
| State Holidays 2026 and 2027.pdf | ||
| Attachment 1 Bidder Form.docx | DOCX document | |
| Attachment 2 Qualification Form.docx | DOCX document | |
| Attachment 4 Joint Contractor and Subcontractor Listing Form.docx | DOCX document | |
| AG008 103D.pdf |
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Text version
STATE OF HAWAIʻI
DEPARTMENT OF HUMAN RESOURCES DEVELOPMENT
HRS §103-55.5 CERTIFICATION WAGE COMPLIANCE FORM
DHRD IFB NO. 27-02-ASO
INSTRUCTIONS TO BIDDERS:
Prior to entering into a public works construction contract in excess of $2,000 that is subject to Chapter 104, HRS, the Bidder must complete and submit this certification form. Failure to submit this form will result in the bid being rejected as non-responsive.
SECTION 1: BIDDER PROFILE
Legal Name of Bidder / Joint Venture:
Hawaii Contractor License No:
(e.g., C-7, ABC-12345) Contractor License Classifications:
(Must include C-7)
| Authorized Contact Person: |
| Title / Official Designation: |
| Business Email Address: |
| Direct Telephone Number: |
SECTION 2: STATUTORY COMPLIANCE CERTIFICATIONS
In accordance with Hawaii Revised Statutes (HRS) §103-55.5, the undersigned Bidder hereby certifies and agrees that if awarded the contract under this solicitation:
1. Prevailing Wages Compliance (HRS Chapter 104):
The Bidder complies and will comply with all provisions, mandates, and requirements of HRS Chapter 104 (Wages and Hours of Employees on Public Works). All laborers and mechanics performing carpet laying, flooring work, or related installation services on the jobsite shall be paid no less than the prevailing wages established by the Director of Labor and Industrial Relations (DLIR) in the applicable Wage Rate Schedule and its authorized addenda.
2. Personnel and Overtime Mandates:
The Bidder certifies that all applicable wage rates, overtime structures, and payroll recordkeeping protocols shall be maintained precisely as required by law. The applicable Wage Rate Schedule shall be prominently posted at the jobsite, and copies of certified weekly payrolls shall be maintained and provided to the State Contract Administrator as required.
3. Subcontractor Liability Flowdown:
The Bidder acknowledges sole contractual responsibility for ensuring absolute compliance across all tiers of subcontractors engaged for this construction project. The Bidder ensures that any subcontractor performing work on this project holds a valid, active license and pays their personnel no less than the mandated prevailing wage thresholds.
4. Enforcement, Withholding, and Penalties:
The Bidder explicitly acknowledges that under HRS Chapter 104 and the contract General Conditions, the State retains the full statutory right to inspect records on-site, interview personnel, and withhold accrued project invoice payments to satisfy proven underpayments, wage shortfalls, or safety infractions caused by the Bidder or its subcontractors.
SECTION 3: BINDING BIDDER EXECUTION & SIGN-OFF
BY SIGNING BELOW, the Bidder certifies under penalty of law that this declaration has been thoroughly examined and is true, accurate, and complete. The individual signing below warrants that they are fully authorized to legally bind the bidding entity named herein to all provisions, restrictions, and statutory requirements of HRS §103-55.5 and Chapter 104.
Authorized Signature:
(Wet/Handwritten or Verified Digital Signature Required) Date Signed:
Printed Full Name of Signatory:
Title / Corporate Office:
Legal Business Entity Name (As submitted in HIePRO Offer):
| Certification Form | DHRD IFB No. 27-02-ASO |
| 2026-09-29 |
File details come from the government source that posted it. Updated .