Offer Form A.pdf
PDF 124 KB Posted
- Attached to
- Washington Place Driveway Recoating
- Solicitation number
- B27000201
- Issued by
- Hawaii
About this file
This is an Offer Form A submitted to the State of Hawaii, Department of Accounting and General Services, Central Services Division for the Washington Place Driveway Recoating project (CSD-27-003-O). The project involves recoating an existing driveway fronting Washington Place along Beretania Street in Honolulu, Hawaii. The offer form requires bidders to declare their business structure, registration status in Hawaii, and provide their Federal I.D. and Hawaii General Excise Tax License numbers. Bidders must demonstrate pavement service experience, maintain a permanent Oahu office location, and designate a point of contact with corresponding contact information. The form requires documentation of insurance coverage across multiple categories including commercial general liability, automobile liability, worker's compensation, temporary disability, prepaid health care, and unemployment insurance.
Bidders must provide a minimum of three references from organizations in Hawaii, other than state government entities, demonstrating experience performing similar roadway and pavement repair services comparable in nature and volume to the specified work. The form requires submission of a list of employees who will perform services, including their position descriptions, as well as a detailed inventory of equipment and vehicles to be utilized on the contract, including license numbers or alternative identification systems. The Department of Accounting and General Services reserves the right to reject any bid from offerors whose previous performance on similar work has been deemed unsatisfactory. Offerors must certify that their pricing was independently determined without collusion and declare compliance with Chapter 84 of the Hawaii Revised Statutes regarding prohibited state contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| OFFER FORM B.xlsx | XLSX spreadsheet | |
| IRS W 9.pdf | ||
| Qualification Form A.pdf | ||
| Plan Drawing.pdf | ||
| Wage Certificate.pdf | ||
| AG-008 103D General Conditions (1.10.23).pdf | ||
| Specifications.pdf | ||
| Special Provisions.pdf |
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Text version
OFFER FORM A Page 1 of 3 CSD-27-003-O
OFFER FORM A
Washington Place Driveway Recoating
CSD-26-027-O
Procurement Officer State of Hawaii, Department of Accounting and General Services, Central Services Division Honolulu, Hawaii 96819
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 Page 2 of 3 CSD-27-003-O
OFFEROR SHALL PROVIDE THE FOLLOWING INFORMATION:
1. Number of years of experience in pavement service:
2. Permanent Oahu Office Location: _______
Telephone Number:
3. Point of Contact:
Name: ______________________________
Telephone Number: FAX No.: _________________________
Cell Phone Number:
E-mail address: __________________________________________
Hawaii License No.: _________________________________________
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 Page 3 of 3 CSD-27-003-O
References: Offeror shall list at least three (3) references in the State of Hawaii, other than State of Hawaii government, for whom offeror has or is performing roadway and pavement repair 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
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
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 and alternative means of identification (e.g. numbering or lettering system) to designate the different equipment. If additional space is required, attach separate sheet and include the information requested.
EQUIPMENT LICENSE NUMBER
Offeror _______________________________________ Name of Company
OFFER FORM A
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