Qualification Form A.pdf
PDF 93 KB Posted
- Solicitation number
- B27000256
- Issued by
- Hawaii
About this file
This is a Qualification Form A related to a plumbing services contract opportunity with the State of Hawaii, Department of Accounting and General Services - Central Services Division (CSD). The contract requires the contractor to furnish all labor, materials, parts, tools, equipment, transportation, and supervision necessary to provide comprehensive plumbing services, including fire sprinkler services, on a task-order as-needed basis. The scope encompasses various locations within Hawaii and is designed to provide flexible, on-call support for the state's plumbing and fire sprinkler maintenance and repair needs.
The qualification form establishes the administrative and technical requirements that prospective contractors must meet to be eligible for consideration. This document serves as a preliminary screening mechanism to ensure that only qualified vendors with appropriate credentials, experience, licensing, and bonding capacity advance in the procurement process. The form typically requires documentation of contractor qualifications, insurance coverage, references, and compliance with state regulations specific to plumbing and fire suppression systems work.
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Other files
| File | Type | Posted |
|---|---|---|
| Specifications.pdf | ||
| Offer Form B.xlsx | XLSX spreadsheet | |
| Wage Certificate.pdf | ||
| AG-008 103D General Conditions (1.10.23).pdf | ||
| Offer Form A.pdf | ||
| IRS W 9.pdf | ||
| Special Provisions.pdf |
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Text version
QUALFICATION FORM A QFA-1 CSD-27-004-O
QUALIFICATION FORM A
PLUMBING SERVICES, INCLUDING FIRE SPRINKLER SERVICES, AT
VARIOUS STATE FACILITIES ON OAHU
CSD-27-004-O
The Offeror and his personnel shall meet the Experience and Personnel Qualifications as indicated in the Special Provisions of this bid. Please complete this form as fully and explicitly as possible to facilitate our evaluation of your firm. Use additional sheets and substantiating documents when necessary.
A. OFFEROR INFORMATION
Exact Legal Name of Contractor: __________________________________________
Plumbing Contractor’s License No.: _____________________
Telephone No.: ___________________ Fax No.: _____________________
Email Address: _____________________________
Contact Person: ____________________________
Telephone No. of Contact Person (if different from above): ______________________
Cellphone No. of Contact Person: ________________________
Oahu Service Facility Location: _______________________________________________ Street Address City State Zip Code
B. CONTACT INFORMATION FOR EMERGENCY SERVICE – DURING WORKING HOURS:
Contact Person: ____________________________
Telephone No. of Contact Person: ____________________________
C. CONTACT INFORMATION FOR EMERGENCY SERVICE – AFTER HOURS:
Contact Person: ____________________________
Telephone No. of Contact Person: __________________________
Cellphone No. of Contact Person: __________________________
Fax No.: ____________________ Email Address: __________________________
Offeror ______________________________ Name of Company
QUALFICATION FORM A QFA-2 CSD-27-004-O
D. OFFEROR QUALIFICATIONS
I. Contractor's/Offeror’s number of consecutive years of experience (immediately prior to bid opening date) in the field of Plumbing System maintenance and repair service:
Contractor's/Offeror’s number of consecutive years of experience (immediately prior to bid opening date) in the field of Fire Sprinkler System maintenance and repair service:
Are services to be rendered by company employees similar or equal to public officers and employees listed in the attached employee classification description?
Yes _____ No _____
If yes, list positions: _________________________________________________
II. List at least three (3) journeymen licensed plumbers who will be assigned to this contract to perform plumbing and fire sprinkler system maintenance/repair work. Each plumber must have a minimum of five (5) consecutive years (immediately prior to bid opening) of maintenance and repair experience on the types of systems as indicated in the Specifications.
1. Journeyman Plumber’s Name: ____________________________
a. Years of Experience: ________________
b. Years of Experience with present employer: ________________
c. Type and Date of Course of Studies completed: ________________________
d. Previous Employers and Dates of Employment the plumber worked for and performed plumbing system maintenance/repair:
2. Journeyman Plumber’s Name: ____________________________
a. Years of Experience: ________________
b. Years of Experience with present employer: ________________
c. Type and Date of Course of Studies completed: ________________________
d. Previous Employers and Dates of Employment the plumber worked for and
QUALFICATION FORM A QFA-3 CSD-27-004-O
performed plumbing system maintenance/repair:
3. Journeyman Plumber’s Name: ____________________________
b. Years of Experience with present employer: ________________
c. Type and Date of Course of Studies completed: ________________________
d. Previous Employers and Dates of Employment the plumber worked for and performed plumbing system maintenance/repair:
III. List at least two (2) plumbers that will be assigned to this contract to assist the journeymen plumbers. These plumbers must be different from the three journeymen plumbers listed above. Each plumber must have a minimum of three (3) consecutive years (immediately prior to the bid opening) of maintenance/repair experience on types of equipment as indicated in the Specifications. Each plumber shall be/have successfully completing/(ed) a course of study in the field of piping systems fabrication, installation, maintenance, and repair, including equipment and fixtures.
1. Plumber’s Name: ____________________________
a. Years of Experience: ________________
b. Years of Experience with present employer: ________________
c. Type and Date of Course of Studies completing/(ed): _____________________
d. Previous Employers and Dates of Employment the plumber worked for and performed plumbing system maintenance/repair:
2. Plumber’s Name: ____________________________
b. Years of Experience with present employer: ________________
c. Type and Date of Course of Studies completing/(ed): _____________________
d. Previous Employers and Dates of Employment the plumber worked for and performed plumbing system maintenance/repair:
QUALFICATION FORM A QFA-4 CSD-27-004-O
IV. Offeror shall list at least five (5) references in the State of Hawaii other than the State of
Hawaii government, for whom offeror has performed Plumbing and Fire Sprinkler system maintenance and repair services on a regular basis, that is similar in nature and volume to the services specified in this bid, that will qualify offeror to perform the project.
The State reserves the right to reject a bid submitted by any offeror whose performance on other jobs for this type of service have been proven unsatisfactory.
1. Name of Firm: ____________________________ Address: _________________________________ Contact Person: ______________________ Telephone No.: ___________________ Annual Project Volume ($): __________________
2. Name of Firm: ____________________________ Address: _________________________________ Contact Person: ______________________
3. Name of Firm: ____________________________
Contact Person: ______________________
4. Name of Firm: ____________________________
Contact Person: ______________________
5. Name of Firm: ____________________________
QUALFICATION FORM A QFA-5 CSD-27-004-O
Contact Person: ______________________
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