Offer Form A.pdf
PDF 105 KB Posted
- Attached to
- SERVICE TRUCKS FOR CENTRAL SERVICES DIVISION
- Solicitation number
- B27000456
- Issued by
- Hawaii
About this file
This is an Offer Form A for a State of Hawaii, Department of Accounting and General Services, Central Services Division procurement (CSD-27-006-O) for the acquisition of service trucks. The procurement seeks bids for two tradesman work trucks with an option to purchase a third unit. Offerors must submit completed forms in accordance with the Invitation for Bids, including all Specifications, Special Provisions, and General Conditions. The form requires offerors to certify that their pricing was independently arrived at without collusion and that the offer does not violate Chapter 84, Hawaii Revised Statutes, concerning prohibited state contracts.
The Offer Form A requires offerors to provide company information including federal identification number, Hawaii General Excise Tax License ID, business address, and payment address. Offerors must designate their business structure (sole proprietor, partnership, corporation, joint venture, or other) and indicate whether they are a Hawaii business incorporated under state law or a compliant non-Hawaii business registered to do business in Hawaii. The form mandates submission of contact information for contract administration, including designated contact person, phone number, and email address. Additionally, offerors must provide insurance coverage information for commercial general liability, automobile liability, worker's compensation, temporary disability, prepaid health care, unemployment insurance, and State of Hawaii Department of Labor registration, listing the carrier, policy number, and agent for each applicable coverage type.
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Other files
| File | Type | Posted |
|---|---|---|
| Specifications.pdf | ||
| IRS W 9.pdf | ||
| AG-008 103D General Conditions (1.10.23).pdf | ||
| Offer Form B.xlsx | XLSX spreadsheet | |
| Special Provisions.pdf |
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Text version
OFFER FORM A OFA-1 CSD-27-006-O
OFFER FORM A
SERVICE TRUCKS FOR CENTRAL SERVICES DIVISION
CSD-27-006-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 OFA-2 CSD-27-006-O
OFFEROR SHALL PROVIDE THE FOLLOWING INFORMATION:
A. Contact information for Contract:
Contact Person: _______________________
Contact Person’s Phone No.: __________________
Contact Person’s E-mail Address: _________________________________
B. 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 |
| SERVICE TRUCKS FOR CENTRAL SERVICES DIVISION |
| CSD-27-006-O |
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