Attachment A – Offor Form A

OFFER FORM A OFA - 1 CSDR-26-016-SW

OFFER FORM A

COMPUTERIZED MAINTENANCE MANAGEMENT SYSTEM (CMMS)

CSDR-26-016-SW

Procurement Officer State of Hawaii, Department of Accounting and General Services, Central Services Division 729 Kakoi Street, Honolulu, Hawaii 96819

To Whom It May Concern:

The undersigned has carefully read and understands the terms and conditions specified in the Request for Proposals, including the Specifications, Special Provisions and General Conditions attached hereto and hereby submits the following offer to perform the work specified herein, all in accordance with the true intent and meaning thereof. The undersigned further understands and agrees that by submitting this offer, 1) he/she is declaring his/her offer is not in violation of Chapter 84, Hawaii Revised Statutes, concerning prohibited State contracts, and 2) he/she is certifying that the price(s) submitted was (were) independently arrived at without collusion.

The undersigned represents: (Check one only)

A Hawaii business incorporated or organized under the laws of the State of Hawaii; OR

A Compliant Non-Hawaii business not incorporated or organized under the laws of the State of Hawaii, but registered at the State of Hawaii, Department of Commerce and Consumer Affairs Business Registration Division to do business in the state of Hawaii.

State of Incorporation: _________________________________________________

Offeror is:

Sole Proprietor Partnership *Corporation Joint Venture Other _______________

Federal I.D. No.: ______________________________

Hawaii General Excise Tax License I.D. No.:

Payment address (other than street address below):___________________ ______________ _

City, State, Zip Code:________

Business address (street address):

City, State, Zip Code:___

Respectfully submitted:

Date: (x) Authorized (Original) Signature Telephone No.:

Fax No.: Name and Title (Please Type or Print)

E-mail Address: ** Exact Legal Name of Company (Offeror)

**If Offeror is a “dba” or a “division” of a corporation, furnish the exact legal name of the corporation under which the awarded contract will be executed: ___

OFFER FORM A OFA - 2 CSDR-26-016-SW

OFFEROR SHALL PROVIDE THE FOLLOWING INFORMATION:

1. Number of years of experience:

2. Permanent Oahu Office Location: _______

Telephone Number:

3. Point of Contact:

Name: ______________________________

Telephone Number: FAX No.: _________________________

Cell Phone Number:

E-mail address: __________________________________________

Insurance coverage is carried by, if applicable:

Carrier Policy No. Agent Commercial General Liability:

Automobile Liability:

Worker’s Compensation:

Temporary Disability:

Prepaid Health Care:

Unemployment Insurance: State of Hawaii, Dept. of Labor No. __________________________

Offeror _______________________________________ Name of Company

OFFER FORM A OFA - 3 CSDR-26-016-SW

Current Contracts. List of current contracts that Offeror is actively servicing at the time of bid submittal.

References: Offeror shall list at least three (3) references in the State of Hawaii, if applicable, other than State of Hawaii government, for whom offeror has or is performing similar services on a regular basis. Services shall be similar in nature and volume to the services specified in this bid qualifying offeror to perform the work. The DAGS/CSD reserves the right to reject a bid submitted by any offeror whose performance on other jobs for this type of service has been proven unsatisfactory.

Name of Firm

Address

Contact Person

Telephone

OFFER FORM A OFA - 4 CSDR-26-016-SW

Employees Performing Services. Offeror shall list employees and their position description. If additional space is required, attach separate sheet and include the information requested.

NAME POSITION/DESCRIPTION

OFFER FORM A OFA - 5 CSDR-26-016-SW

Equipment/Vehicles. Offeror shall list equipment and/or vehicles to be used to service this contract.

The list must include vehicle/equipment license numbers. If a license number is not available, Offeror must provide alternative means of identification (e.g. numbering or lettering system) to designate the different equipment. If additional space is required, attach separate sheets and include the information requested.

EQUIPMENT LICENSE NUMBER