UPS Batteries Replacement at IT Center and Keller Hall

IFB NO. 26-5690
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MANDATORY BID FORM
Bidders must download The Mandatory Bid Form in its entirety (open, save, or print
documents(s) on their own computer system), enter pricing where indicated, complete any
other required information, sign all appropriate forms, and attach (upload) the completed
Mandatory Bid Form to their HIePRO online bid submission.
BID CHECKLIST
THE FOLLOWING ITEM IN THIS TABLE MUST BE ADDRESSED AND THE COMPLETED
BID CHECKLIST SHALL BE UPLOADED WITH THE BIDDERS HIEPRO SUBMISSION.
REQUIREMENT DESCRIPTION ACTION REQUIRED COMPLETE
Bid Requirements Read and understood
Technical Specifications Read and understood
Special Provisions Read and understood
Eaton Certification Letters Complete, sign, and attach to HIePRO*
Bid Price List Complete, sign, and attach to HIePRO*
Business Classification Statement Complete, sign, and attach to HIePRO
Bid Signature Page Complete, sign, and attach to HIePRO
* The University is not responsible for any errors in bid calculations or extensions not attributed to
a system error
MANDATORY BID FORM

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BID PRICE LIST
Bidders must bid on all items in order to be considered for award. To ensure compatibility with
the University's existing equipment, only the brand name(s) and part numbers specified will be
accepted.
Item Part No. Description Quantity Unit Price Total Amount
No.
1 EF391BAA03 Enersys DataSafe 16HX800 90 x $_________ = $_____________
UPS Batteries
No Substitutions.
2 EF391BAA02 Enersys DataSafe 16HX800 90
UPS Batteries
No Substitutions.
3 EF391BAA01 Enersys DataSafe 16HX800 90 x $_________ = $_____________
UPS Batteries
No Substitutions.
4 EU094ZBA01 PWHR12330W4FR Battery 40 x $_________ = $_____________
Replacement
No Substitutions.
TOTAL AMOUNT (ITEM NO. 1-4) = $_____________
Total Amount shall include all labor and equipment costs, shipping transportation (f.o.b. destination)
and delivery costs, insurance premiums, warranty costs, administrative costs, expediting fees, and all
applicable fees and taxes (Federal and State).
MANDATORY BID FORM

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(IF BY INDIVIDUAL) NAME (Signature) TYPED NAME
D.B.A.
___________________________
FEDERAL TAXPAYER ADDRESS
IDENTIFICATION NUMBER
CITY STATE ZIP CODE
______________________________
EMAIL ADDRESS TELEPHONE NUMBER FAX NUMBER
(IF BY PARTNERSHIP) OFFICIAL/LEGAL NAME OF FIRM
___________________________
FEDERAL TAXPAYER NAME (Signature) TYPED NAME
IDENTIFICATION NUMBER
PARTNER
______________________________
EMAIL ADDRESS ADDRESS
CITY STATE ZIP CODE
TELEPHONE NUMBER FAX NUMBER
(IF BY CORPORATION) OFFICIAL/LEGAL NAME OF COMPANY
___________________________
FEDERAL TAXPAYER
IDENTIFICATION NUMBER
*OFFICER (Signature) TYPED NAME
______________________________
EMAIL ADDRESS TITLE
ADDRESS OF COMPANY
CITY STATE ZIP CODE
TELEPHONE NUMBER FAX NUMBER
(SEAL)
IF LICENSED OR INCORPORATED TO DO BUSINESS WITHIN THE STATE OF HAWAII AND SUBJECT TO THE
PROVISIONS OF THE HAWAII GENERAL EXCISE TAX LAWS, INDICATE GENERAL EXCISE TAX LICENSE NUMBER
__________________________.
*For Corporations include evidence of the authority of this officer to submit a bid on behalf of the corporation, giving also, the address and names
and addresses of the other officers.
NOTE: FILL IN ALL BLANK SPACES WITH INFORMATION ASKED FOR OR BID MAY BE INVALIDAT
MANDATORY BID FORM

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BUSINESS CLASSIFICATION CERTIFICATION STATEMENT
CONTRACTORS: Please complete the information below. Terms used are taken from the U.S. Small
Business Administration (SBA) Rules and Regulations (https://www.sba.gov/) and the U.S. Code of Federal
Regulations (CFR). The term "controlled" refers to the management and daily operation of the business concern.
The company identified below (check all that apply):
1. IS NOT a small business concern as defined in the regulations
(If you checked here, STOP. GO TO CERTIFICATION BELOW.)
IS a small business concern, defined as one that is independently owned and operated,
is organized for profit, is not dominant in its field, meets the SBA size standard eligibility
(see reverse side of this form for examples of size standards), is registered and has its
status represented in the U.S. Government's System for Award Management (SAM)
database. See http://www.sba.gov/content/what-sbas-definition-small-business-concern.
2. IS a small disadvantaged business concern of which at least 51% is unconditionally and
directly owned and controlled by one or more socially disadvantaged and economically
disadvantaged persons who are U.S. citizens. See 13 CFR 124.105 for exceptions.
3. IS a women-owned small business concern of which at least 51% is unconditionally and
directly owned and controlled by one or more women who are U.S. citizens. See 13 CFR
127.
4. IS a HUBZone small business concern that meets the certification eligibility
requirements set by the U.S. SBA. See 13 CFR 126.
5. IS a veteran-owned small business concern of which at least at least 51% is
unconditionally and directly owned by one or more veterans or service-disabled veterans.
See 38 CFR 74.
6. IS a service-disabled veteran-owned small business concern of which at least 51% is
unconditionally and directly owned by one or more service-disabled veterans. In the case
of any publicly owned business, not less than 51% of the stock of which is owned by one or
more service-disabled veterans. The management and daily business operations of which
are controlled by one or more service-disabled veterans, or in the case of a veteran with a
permanent and severe disability, a spouse or permanent caregiver of such veteran. See 13
CFR 125.11 et al.
CERTIFICATION
I hereby certify the information supplied herein to be true and correct. (Any misrepresentation shall be subject to
the provisions stated in item B on the next page.)
Company Name:
Signature of Company Officer
Company Address: Print Name:
Title:
Date:
Type of Goods/Services:
North American Industry Classification System (NAICS) Code:
MANDATORY BID FORM

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A. A small business concern is one that is independently owned and operated, is organized for profit, is not
dominant in its field, has a place of business in the U.S., and operates primarily within the U.S. or makes
a significant contribution to the U.S. economy. Size standard eligibility is based on the average number of
employees for the preceding 12 months or on sales volume averaged over a 3-year period. See 13 CFR
121.201 for size standards identified by NAICS codes. The size standards for a few industries are shown
below and are subject to change at any time.
1. SPECIALTY TRADE CONTRACTORS - "Small" if average annual receipts for preceding 3 years do
not exceed $15 million.
2. CONSTRUCTION, GENERAL CONTRACTORS - "Small" if average annual receipts for preceding 3
years do not exceed $36.5 million.
3. MANUFACTURING - "Small" if 500 employees or less, except for some specific products which will
increase the complement of employees to 750 or 1,000.
4. TRANSPORTATION - "Small" if average annual receipts for preceding 3 years do not exceed the
amount shown for specific services.
$27.5 million - general freight trucking, local.
5. WHOLESALE TRADE, DURABLE AND NON-DURABLE GOODS - "Small" if 100 employees or less.
6. RETAIL TRADE - "Small" if average annual receipts for preceding 3 years do not exceed the amount
shown for specific products.
$7.5 million - hardware stores.
7. SERVICES - "Small" if average annual receipts for preceding 3 years do not exceed the amount
shown for specific services:
a) $27.5 million - computer systems design services, custom computer programming services
$20.5 million - security guards and patrol services
b) $18 million - janitorial services
c) $38.5 million - passenger car rental
d) $32.5 million - office machinery and equipment rental & leasing
e) $7.5 million - general automotive repair
Annual receipts of a concern which has been in business for less than 3 complete fiscal years means the
total receipts for the period the concern has been in business divided by the number of weeks in
business, multiplied by 52. See 13 CFR 121.104.
B. Notice. Under 15 U.S.C. 645(d), any person who misrepresents a firm's status as a small business
concern, a qualified HUBZone small business concern, a small business concern owned and controlled
by socially and economically disadvantaged individuals, or a small business concern owned and
controlled by women in order to obtain a contract to be awarded under the preference programs
established pursuant to 15 U.S.C. sections 637(a), 637(d), 638, 644, or 657(a), shall:
1. Be punished by imposition of fine, imprisonment, or both;
2. Be subject to administrative remedies including suspension and debarment; and
3. Be ineligible for participation in a program conducted under the authority of the Small Business
Investment Act of 1958.
MANDATORY BID FORM