Offer Form A.pdf
PDF 113 KB Posted
- Attached to
- Washington Place Driveway Recoating
- Solicitation number
- B27000464
- Issued by
- Hawaii
About this file
This is an Offer Form A for a state and local contract opportunity issued by the State of Hawaii, Department of Accounting and General Services, Central Services Division, for the Washington Place Driveway Recoating project (CSD-27-007-O). The project involves recoating the Washington Place Beretania Street driveway. The offer form serves as the submission document through which bidders declare their intent to perform the specified work in accordance with the invitation for bids, specifications, special provisions, and general conditions. Offerors must certify that their pricing was independently arrived at without collusion and that their offer does not violate Chapter 84, Hawaii Revised Statutes concerning prohibited state contracts.
The offer form requires offerors to provide company information including business type, federal and state tax identification numbers, permanent Oahu office location, point of contact details, and relevant licensing information. Offerors must also disclose years of experience in pavement service and provide comprehensive insurance coverage details, including commercial general liability, automobile liability, workers' compensation, temporary disability, prepaid health care, and unemployment insurance. The form distinguishes between Hawaii-incorporated businesses and compliant non-Hawaii businesses registered to do business in Hawaii, with submission requiring an authorized signature, date, and complete company documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| AG-008 103D General Conditions (1.10.23).pdf | ||
| Special Provisions.pdf | ||
| Specifications.pdf | ||
| Wage Certificate.pdf | ||
| IRS W 9.pdf | ||
| Plan Drawing.pdf | ||
| Qualification Form A.pdf | ||
| OFFER FORM B.xlsx | XLSX spreadsheet |
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Text version
OFFER FORM A Page 1 of 2 CSD-27-007-O
OFFER FORM A
Washington Place Driveway Recoating
CSD-27-007-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 2 CSD-27-007-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
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