IFB D23 103 Additional Offer Pages.pdf

OFFER PAGE

IFB D23-103 OF-1

FURNISH AND DELIVER AIR PURIFIERS WITH REPLACMENT FILTERS FOR THE

HAWAII STATE DEPARTMENT OF EDUCATION HOLOMUA ELEMENTARY SCHOOL

IFB D23-103

Chief Procurement Officer Hawaii State Department of Education Honolulu, Hawaii 96813

To Whom It May Concern:

The undersigned has carefully read and understands the terms and conditions specified in the Specifications, Special Conditions, 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) the undersigned is declaring the undersigned’s offer is not in violation of Chapter 84, Hawaii Revised Statutes, concerning prohibited State contracts, and 2) the undersigned 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, and, if applicable, 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. Number: Hawaii General Tax License I.D. Number:

Payment address (other than street address below):

City, State, Zip Code:

Business address (street address):

City, State, Zip Code:

Date: Respectfully submitted:

Phone Number:

Authorized (Original) Signature Fax Number:

Name and Title (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:

Offeror:

EXHIBIT A

IFB D23-103 EX A-1

EXHIBIT A

OFFEROR INFORMATION

Offeror shall provide the Exhibit A, including attachments if applicable, within three (3) business days from STATE’s request.

A. AUTHORIZED DISTRIBUTOR OR RESELLER

At the time of bidding, Offeror shall be an authorized distributor or reseller for air purifiers and replacement filters. As evidence of this, Offeror may be requested to provide documentation from the manufacturer which verifies Offeror’s status as an authorized distributor or reseller.

Authorized Distributor or Reseller ☐ Yes Documentation Attached

D. PERSONNEL

Offeror shall designate at least one (1) employee as the STATE POC for this contract. This individual shall be available during regular business hours, 7:45 a.m. to 4:30 p.m. HST, Monday through Friday excluding holidays, and shall be capable of answering questions, resolving problems, and providing sales, ordering, and follow-up assistance.

POC Name

Office Telephone Number

Cell Number

Fax Number

Email Address