Offeror Qualification Form.pdf
PDF 124 KB Posted
- Attached to
- Bathroom Facility
- Solicitation number
- B27000057
- Issued by
- Honolulu County, Hawaii
About this file
This is an Offeror Qualification Form for the Hawaii Department of Health at Hawaii State Hospital, which is seeking a contractor to purchase, install, and set up a standalone restroom facility on hospital grounds at 45-710 Kea'ahala Road in Kaneohe, Honolulu County. The form requires offerors to provide their exact legal name, street address, contact person information including cell and telephone numbers, fax number, and email address. Subcontractor information must also be included if applicable. Proposals are due July 31, 2026. The form requires offerors to complete Section 3 regarding vendor requirements and qualifications, and to provide at least three references from firms in the State of Hawaii for whom the offeror has performed similar services within the past five years, including the firm name, address, contact person, telephone number, and email address.
Offerors must complete the Offeror Form OF-1 and certify compliance with all specifications and special provisions while confirming that pricing was independently arrived at without collusion. A Hawaii General Excise Tax License identification is required, and offerors must declare their business structure (sole proprietor, partnership, corporation, joint venture, or other) and provide payment and business addresses. The authorized representative must sign the offer form and provide telephone, fax, and email contact information. Supporting documents required include detailed facility specifications, a W-9 form, general conditions (AG-008 103D), and proof of insurance. Submission certifies that the offer does not violate Chapter 84 of the Hawaii Revised Statutes regarding prohibited state contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| BathroomFacility.docx | DOCX document | |
| W9 Form to be completed by vendor.pdf | ||
| AG-008 103D General Conditions (1.10.23).pdf | ||
| Insurance Requirements.docx | DOCX document | |
| Offeror Form OF1.pdf |
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Text version
OFFEROR’S QUALIFICATION FORM
Please complete this form as fully and explicitly as possible to facilitate evaluation of your firm. Use additional sheets and substantiating documents when necessary.
A. Exact Legal Name of Contractor: ___________________________________________
Street Address
City State Zip Code
Contact Person Name: _________________________ Cell No. ___________________
Telephone No.: _______________________________ Fax No.: __________________
E-mail Address: _______________________________
Subcontractor Name, if applicable: _____________________________________________
Street Address
City State Zip Code
Contact Person Name: _________________________ Cell No. ___________________
Telephone No.: _______________________________ Fax No.: __________________
E-mail Address: _______________________________
B. Experience and Qualifications:
(See Section 3. Vendor Requirement and Qualification)
C. References:
Offeror shall list at least three references in the State of Hawaii, for whom offeror has or is performing similar services within the past 5 years.
1. Name of Firm
Address:
Contact Person
Telephone
2. Name of Firm
Address:
Contact Person
Telephone
3. Name of Firm
Address:
Contact Person
Telephone
File details come from the government source that posted it. Updated .