Offer Form A.pdf
PDF 121 KB Posted
- Attached to
- Washington Place Driveway Recoating
- Solicitation number
- B27000380
- Issued by
- Honolulu County, 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 Invitation for Bids CSD-27-003-O regarding driveway recoating services at Washington Place. The project involves recoating the Beretania Street driveway inside the fencing at 320 S. Beretania Street, Honolulu, Hawaii 96813. The form requires offerors to declare compliance with Hawaii Revised Statutes Chapter 84 regarding prohibited state contracts and to certify that pricing was independently determined without collusion. Offerors must identify their business structure (sole proprietor, partnership, corporation, joint venture, or other), provide their state of incorporation, Federal ID number, and Hawaii General Excise Tax License ID number, along with their business address and payment address if different from their business location.
The offer form requires offerors to provide detailed operational information including years of experience in pavement services, a permanent Oahu office location with contact details, a designated point of contact with multiple contact methods and Hawaii license number, and proof of insurance coverage across multiple categories including commercial general liability, automobile liability, worker's compensation, temporary disability, prepaid health care, and unemployment insurance. Offerors must also list all employees who will perform services under the contract with their position descriptions and provide a complete inventory of equipment and vehicles to be used, including license numbers or alternative identification systems. The form is three pages long and permits offerors to attach additional sheets if space for listing employees, equipment, or vehicles is insufficient.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Specifications.pdf | ||
| OFFER FORM B.xlsx | XLSX spreadsheet | |
| Plan Drawing.pdf | ||
| Special Provisions.pdf | ||
| Wage Certificate.pdf | ||
| Qualification Form A.pdf | ||
| IRS W 9.pdf | ||
| AG-008 103D General Conditions (1.10.23).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-27-003-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
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
File details come from the government source that posted it. Updated .