Attachment 7 Safety and Health Program 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 Safety and Health Program Certification Form from the State of Hawaii, Department of Human Resources Development (DHRD), related to the 12th and 13th Floor Carpet Tile Replacement project at the Leiopapa a Kamehameha Building. The form serves as a certification document that bidders must complete and submit as part of their bid package for the competitive sealed bidding process under Hawaii Revised Statutes Chapter 103D. The certification requires bidders to demonstrate their commitment to maintaining comprehensive safety and health programs throughout the execution of the carpet tile replacement work on the specified floors.
The form establishes safety and health compliance standards that prospective contractors must acknowledge and certify they will implement during project performance. This documentation is essential for bid evaluation and contract award purposes, ensuring that the selected contractor possesses the organizational infrastructure and commitment necessary to conduct the construction work in accordance with applicable safety regulations and the State of Hawaii's requirements. Completion and submission of this certification form is a mandatory requirement for bid submission and represents a binding commitment by the bidder to maintain the safety and health protocols outlined therein throughout the contract term.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 3 Carpet Tile Product 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 | ||
| 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
SAFETY AND HEALTH PROGRAM CERTIFICATION FORM
DHRD IFB NO. 27-02-ASO
Instructions: In accordance with Hawaiʻi Revised Statutes (HRS) Chapter 396, any bidder submitting a bid for a public works construction project with an estimated value exceeding $100,000 is required to certify that it possesses and will fully implement a project-specific written safety and health program. Complete this form and submit it with your bid.
SECTION 1: BIDDER PROFILE & SOLICITATION DETAILS
| Solicitation Number: |
| DHRD IFB NO. 27-02-ASO |
| Project Title: |
| 12th and 13th Floor Carpet Tile Replacement (Leiopapa a Kamehameha Building) |
| Bidder (Legal Business Name): |
| [Enter company legal name] |
| State of Hawaiʻi Contractor License No.: |
| [Enter license number, e.g., C-XXXXX] |
License Classification(s):
| Primary Contact Name & Title: |
| [Enter name and corporate role] |
SECTION 2: MANDATORY SAFETY & HEALTH CERTIFICATIONS
[ ] Written Program Availability:
The Bidder hereby certifies that it maintains a project-specific written safety and health program that fully satisfies the statutory mandates of Hawaiʻi Revised Statutes (HRS) Chapter 396 and all applicable rules of the Hawaiʻi Occupational Safety and Health Division (HIOSH).
[ ] On-Site Implementation:
The Bidder commits that the aforementioned safety and health program shall be fully implemented, operational, and active at the project location (Leiopapa a Kamehameha Building, 12th and 13th floors) on or before the official project commencement date specified in the State's Notice to Proceed (NTP).
[ ] Site-Specific Hazards Coverage:
The written safety and health program explicitly covers construction activities, materials handling, substrate preparation hazards (including compliance protocols for encountering suspected hazardous materials or residual adhesives under Section 41.1), proper ventilation for low-VOC adhesive installations, and pedestrian traffic separation barriers to isolate work zones from state personnel.
[ ] Inspector Access:
The Bidder certifies that a copy of the finalized project-specific written safety and health program shall be maintained continuously on the jobsite and will be made immediately available upon request to the Contract Administrator (Patrick Lam), DHRD representatives, or HIOSH compliance officers throughout the contract term.
SECTION 3: BIDDER ATTESTATION & LEGAL EXECUTION
BY SIGNING BELOW, the undersigned certifies on behalf of the Bidder that they are fully authorized to execute this document, that the statements checked above are complete and accurate in fact, and that full compliance with HRS Chapter 396 safety provisions is a binding condition of contract award and performance.
Authorized Signature:
Date Signed:
Printed Name & Title:
License Number:
Full Legal Company Name:
Phone / Email:
| Safety and Health Program Certification Form | DHRD IFB 27-02-ASO | |
| 2026-09-29 |
File details come from the government source that posted it. Updated .