Attachment A Proposal Identification Form OF1.pdf
PDF 208 KB Posted
- Solicitation number
- P25001422
- Issued by
- Honolulu County, Hawaii
About this file
This is a Proposal Identification Form (OF1) for the State of Hawaii Department of Health, Disease Outbreak Control Division and Health Data & Informatics Office located in Honolulu. The form serves as a cover sheet for proposal submissions in response to an unspecified RFP, requiring offerors to certify their compliance with Chapter 84 of Hawaii Revised Statutes regarding prohibited State contracts and confirm that their pricing was determined independently without collusion.
The form requires basic business information including the legal name, contact details, tax ID numbers, and business structure (Individual, Partnership, Corporation, Joint Venture, or LLC) of the offering entity. It includes fields for Hawaii General Excise Tax ID number, Social Security or Federal Identification number, and state of incorporation. The form also requires specification if the offeror is operating under a "dba" or as a division of a corporation. No specific pricing terms, set-asides, or funding requirements are detailed in this standard proposal submission form.
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Text version
ATTACHMENT A - PROPOSAL IDENTIFICATION FORM OF1
State of Hawaii Department of Health Disease Outbreak Control Division Health Data & Informatics Office 1000 Bishop Street Honolulu, Hawaii 96813
To Whom It May Concern:
The undersigned has carefully read and understands the terms and conditions specified in this RFP and hereby submits the following proposal to perform the work specified in the RFP.
The undersigned further understands and agrees that by submitting this proposal, 1) the designee is declaring that the designee's proposal is not in violation of Chapter 84, Hawaii Revised Statutes, concerning prohibited State contracts, and 2) the designee is certifying that the price(s) submitted was (were) independently arrived at without collusion.
Respectfully submitted, Date Exact Legal Name of Offeror
Telephone No. Authorized Signature
Fax No. Title
Street Address
__________________________ City, State, Zip Code
Payment Address, if different
Hawaii General Excise Tax I.D. No. ___________________________________
Social Security of Federal Identification No. _____________________________
If Offeror shown above is a “dba” or a “division” of a corporation, furnish the exact legal name of the corporation under which the contract, if awarded, will be executed:
Offeror is: __Individual __Partnership __Corporation __Joint Venture __LLC
State of incorporation: __Hawaii ____________________Other
File details come from the government source that posted it. Updated .