IFB MBF.pdf

IFB NO. 26-5690

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MANDATORY BID FORM

Bidders must download The Mandatory Bid Form in its entirety (open, save, or print documents(s) on their own computer system), enter pricing where indicated, complete any other required information, sign all appropriate forms, and attach (upload) the completed Mandatory Bid Form to their HIePRO online bid submission.

BID CHECKLIST

THE FOLLOWING ITEM IN THIS TABLE MUST BE ADDRESSED AND THE COMPLETED

BID CHECKLIST SHALL BE UPLOADED WITH THE BIDDERS HIEPRO SUBMISSION.

REQUIREMENT DESCRIPTION ACTION REQUIRED COMPLETE

Bid Requirements Read and understood

Technical Specifications Read and understood

Special Provisions Read and understood

Eaton Certification Letters Complete, sign, and attach to HIePRO*

Bid Price List Complete, sign, and attach to HIePRO*

Business Classification Statement Complete, sign, and attach to HIePRO

Bid Signature Page Complete, sign, and attach to HIePRO

* The University is not responsible for any errors in bid calculations or extensions not attributed to a system error

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BID PRICE LIST

Bidders must bid on all items in order to be considered for award. To ensure compatibility with the University’s existing equipment, only the brand name(s) and part numbers specified will be accepted.

Item No.

Part No. Description Quantity Unit Price Total Amount

1 EF391BAA03

Enersys DataSafe 16HX800 UPS Batteries

No Substitutions.

90 x $_________ = $_____________

2 EF391BAA02 Enersys DataSafe 16HX800 UPS Batteries

No Substitutions.

3 EF391BAA01 Enersys DataSafe 16HX800 UPS Batteries

No Substitutions.

90 x $_________ = $_____________

4 EU094ZBA01 PWHR12330W4FR Battery Replacement

No Substitutions.

40 x $_________ = $_____________

TOTAL AMOUNT (ITEM NO. 1-4)

Total Amount shall include all labor and equipment costs, shipping transportation (f.o.b. destination) and delivery costs, insurance premiums, warranty costs, administrative costs, expediting fees, and all applicable fees and taxes (Federal and State).

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(IF BY INDIVIDUAL) NAME (Signature) TYPED NAME

D.B.A.

FEDERAL TAXPAYER ADDRESS

IDENTIFICATION NUMBER

CITY STATE ZIP CODE

EMAIL ADDRESS TELEPHONE NUMBER FAX NUMBER

(IF BY PARTNERSHIP) OFFICIAL/LEGAL NAME OF FIRM

FEDERAL TAXPAYER NAME (Signature) TYPED NAME

IDENTIFICATION NUMBER

PARTNER

EMAIL ADDRESS ADDRESS

TELEPHONE NUMBER FAX NUMBER

(IF BY CORPORATION) OFFICIAL/LEGAL NAME OF COMPANY

FEDERAL TAXPAYER

IDENTIFICATION NUMBER

*OFFICER (Signature) TYPED NAME

EMAIL ADDRESS TITLE

ADDRESS OF COMPANY

TELEPHONE NUMBER FAX NUMBER

(SEAL)

IF LICENSED OR INCORPORATED TO DO BUSINESS WITHIN THE STATE OF HAWAII AND SUBJECT TO THE PROVISIONS OF THE HAWAII GENERAL EXCISE TAX LAWS, INDICATE GENERAL EXCISE TAX LICENSE NUMBER *For Corporations include evidence of the authority of this officer to submit a bid on behalf of the corporation, giving also, the address and names and addresses of the other officers.

NOTE: FILL IN ALL BLANK SPACES WITH INFORMATION ASKED FOR OR BID MAY BE INVALIDAT

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BUSINESS CLASSIFICATION CERTIFICATION STATEMENT

CONTRACTORS: Please complete the information below. Terms used are taken from the U.S. Small Business Administration (SBA) Rules and Regulations (https://www.sba.gov/) and the U.S. Code of Federal Regulations (CFR). The term “controlled” refers to the management and daily operation of the business concern.

The company identified below (check all that apply):

1.

IS NOT a small business concern as defined in the regulations (If you checked here, STOP. GO TO CERTIFICATION BELOW.)

IS a small business concern, defined as one that is independently owned and operated, is organized for profit, is not dominant in its field, meets the SBA size standard eligibility (see reverse side of this form for examples of size standards), is registered and has its status represented in the U.S. Government’s System for Award Management (SAM) database. See http://www.sba.gov/content/what-sbas-definition-small-business-concern.

2.

IS a small disadvantaged business concern of which at least 51% is unconditionally and directly owned and controlled by one or more socially disadvantaged and economically disadvantaged persons who are U.S. citizens. See 13 CFR 124.105 for exceptions.

3.

IS a women-owned small business concern of which at least 51% is unconditionally and directly owned and controlled by one or more women who are U.S. citizens. See 13 CFR 127.

4.

IS a HUBZone small business concern that meets the certification eligibility requirements set by the U.S. SBA. See 13 CFR 126.

5.

IS a veteran-owned small business concern of which at least at least 51% is unconditionally and directly owned by one or more veterans or service-disabled veterans.

See 38 CFR 74.

6.

IS a service-disabled veteran-owned small business concern of which at least 51% is unconditionally and directly owned by one or more service-disabled veterans. In the case of any publicly owned business, not less than 51% of the stock of which is owned by one or more service-disabled veterans. The management and daily business operations of which are controlled by one or more service-disabled veterans, or in the case of a veteran with a permanent and severe disability, a spouse or permanent caregiver of such veteran. See 13 CFR 125.11 et al.

CERTIFICATION

I hereby certify the information supplied herein to be true and correct. (Any misrepresentation shall be subject to the provisions stated in item B on the next page.)

Company Name:

Signature of Company Officer

Company Address: Print Name:

Title:

Date:

Type of Goods/Services:

North American Industry Classification System (NAICS) Code:

https://www.sba.gov/ http://www.sba.gov/content/what-sbas-definition-small-business-concern

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A. A small business concern is one that is independently owned and operated, is organized for profit, is not dominant in its field, has a place of business in the U.S., and operates primarily within the U.S. or makes a significant contribution to the U.S. economy. Size standard eligibility is based on the average number of employees for the preceding 12 months or on sales volume averaged over a 3-year period. See 13 CFR

121.201 for size standards identified by NAICS codes. The size standards for a few industries are shown below and are subject to change at any time.

1. SPECIALTY TRADE CONTRACTORS – “Small” if average annual receipts for preceding 3 years do not exceed $15 million.

2. CONSTRUCTION, GENERAL CONTRACTORS – “Small” if average annual receipts for preceding 3 years do not exceed $36.5 million.

3. MANUFACTURING – “Small” if 500 employees or less, except for some specific products which will increase the complement of employees to 750 or 1,000.

4. TRANSPORTATION – “Small” if average annual receipts for preceding 3 years do not exceed the amount shown for specific services.

$27.5 million – general freight trucking, local.

5. WHOLESALE TRADE, DURABLE AND NON-DURABLE GOODS – “Small” if 100 employees or less.

6. RETAIL TRADE – “Small” if average annual receipts for preceding 3 years do not exceed the amount shown for specific products.

$7.5 million – hardware stores.

7. SERVICES – “Small” if average annual receipts for preceding 3 years do not exceed the amount shown for specific services:

a) $27.5 million – computer systems design services, custom computer programming services $20.5 million – security guards and patrol services

b) $18 million – janitorial services

c) $38.5 million – passenger car rental

d) $32.5 million – office machinery and equipment rental & leasing

e) $7.5 million – general automotive repair

Annual receipts of a concern which has been in business for less than 3 complete fiscal years means the total receipts for the period the concern has been in business divided by the number of weeks in business, multiplied by 52. See 13 CFR 121.104.

B. Notice. Under 15 U.S.C. 645(d), any person who misrepresents a firm’s status as a small business concern, a qualified HUBZone small business concern, a small business concern owned and controlled by socially and economically disadvantaged individuals, or a small business concern owned and controlled by women in order to obtain a contract to be awarded under the preference programs established pursuant to 15 U.S.C. sections 637(a), 637(d), 638, 644, or 657(a), shall:

1. Be punished by imposition of fine, imprisonment, or both;

2. Be subject to administrative remedies including suspension and debarment; and

3. Be ineligible for participation in a program conducted under the authority of the Small Business

Investment Act of 1958.