Offer Form A .pdf

OFFER FORM A OFA-1 CSD-26-026-O

OFFER FORM A

CSD-26-026-O

FURNISH ALL LABOR FOR INSTALLATION OF CHAIN LINK FENCING FOR THE FOR THE

DEPARTMENT OF ACCOUNTING AND GENERAL SERVICES, CENTRAL SERVICES DIVISION.

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 this Request for Quotes (RFQ), 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)

OFFER FORM A OFA-2 CSD-26-026-O

**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:

OFFEROR SHALL PROVIDE THE FOLLOWING INFORMATION:

1. Offeror’s Permanent Oahu Office and Service Facility Location (address):

Telephone Number:

2. Point of Contact:

Name:

Telephone Number: FAX No.:

Cell Phone Number:

E-mail address:

3. 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.

4. List of References. Offeror shall list at least three (3) references in the State of Hawaii (other than the State Government) for whom offeror has or is performing services on a regular basis as specified herein:

Name Address Contact Person Telephone

1.

OFFER FORM A OFA-3 CSD-26-026-O

Name Address Contact Person Telephone

2.

3.

Offeror (Name of Company)