Offer Form A.pdf
PDF 135 KB Posted
- Attached to
- Honokaa State Office Building Roof Repairs
- Solicitation number
- B26003380
- Issued by
- Hawaii County, Hawaii
About this file
This is an Offer Form A document issued by the State of Hawaii, Department of Accounting and General Services (DAGS), Central Services Division, for the Honokaa State Office Building Roof Repairs project (RFQ No. CSD-26-100-O). The solicitation requests bids for temporary roof repairs to address active water infiltration at the Honokaa State Office Building. Work scope includes furnishing all labor, materials, equipment, and supervision necessary to install either a Snap-Clad metal roofing overlay system or a TPO membrane overlay system over the existing roof and skylight area. Offerors are required to provide bids for both line items, with the State reserving the right to select and award one line item.
The Offer Form A requires offerors to declare their business status as either a Hawaii business incorporated under Hawaii law or a compliant non-Hawaii business registered to conduct business in Hawaii. Offerors must provide detailed information including Federal I.D. number, Hawaii General Excise Tax License I.D. number, business address, and proof of required insurance coverage (commercial general liability, automobile liability, worker's compensation, temporary disability, prepaid health care, and unemployment insurance). Additionally, offerors must provide their Hawaii Contractor License Number and certify that their submitted price was independently arrived at without collusion and is not in violation of Chapter 84, Hawaii Revised Statutes concerning prohibited State contracts.
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Text version
OFFER FORM A OFA-1 RFQ No. CSD-26-100-O
OFFER FORM A
HONOKAA STATE OFFICE BUILDING – ROOF REPAIRS
Procurement Officer State of Hawaii, Department of Accounting and General Services, West Hawaii District Office Kealakekua, Hawaii 96750
To Whom It May Concern:
The undersigned has carefully read and understands the terms and conditions specified in the Invitation for Bids, 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 RFQ No. CSD-26-100-O
OFFEROR SHALL PROVIDE THE FOLLOWING INFORMATION:
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. _
Contractor xxx License Number: __________________
Offeror _______________________________________ Name of Company
OFFER FORM A
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