VARIOUS STATE FORMS AND SPO PL CONTRACT NO 19-01 NON-PRINTED CARBONLESS PAPER 2 ORDER DEADLINE DATE: 4/15/2019

STATE OF HAWAII STATE PROCUREMENT OFFICE

SPO Price List Contract No. 19-01

Replaces SPO PL Contract No. 18-01 Effective: 4/2/2019

VARIOUS STATE FORMS AND NON-PRINTED CARBONLESS

PAPER - STATEWIDE (IFB-19-001-SW) Requirements for Calendar Year 2019

ORDER DEADLINE DATE: APRIL 15, 2019 PARTICIPATING JURISDICTIONS listed below have signed a cooperative agreement with the SPO and are required to utilize this price list contract.

Executive Departments/Agencies Hawaii Health Systems Corporation Office of Hawaiian Affairs House of Representatives Senate Judiciary

USE OF THE PRICE LIST CONTRACT. Per Requirements Circular No. C19-01 dated September 28, 2018, the jurisdiction quantity requirements were submitted in response to the circular and are firm commitments to purchase various state forms and non-printed carbonless paper. Agencies shall place orders directly with the Contractor for their quantities submitted. In the event an agency listed on the attached Agency Requirements fails to submit its order by April 15, 2019, the Contractor has the option to automatically process the order at the contracted price. If the Contractor exercises this option, they shall contact the agency for delivery coordination and imprinting/pre-numbering information, if applicable, and invoice appropriately. Quantities listed on the attached Agency Requirements represent a minimum amount. The State reserves the right to purchase larger quantities for Group A - Various Standard Snap-Out Forms and Group B - Requisition and PO Forms only, at the prices quoted for this solicitation and the orders shall be placed with the Contractor by April 15, 2019. Agencies not listed in the attached Agency Requirements are allowed to order forms from Group A - Various Standard Snap-Out Forms and Group B - Requisition and PO Forms on or before the order deadline date. EXCEPTION TO THE PRICE LIST CONTRACT. For uncommitted purchases, an exception may be granted when the price list contract does not meet the purchasing agency’s needs. For this purpose, Executive Branch Department Heads (or as delegated by the department head) is granted the authority to make the exception approval. This procedure will allow departments to make their own determination when not practicable or advantageous to use the contract. Executive departments and participating jurisdictions may use form SPO-005, Request for Purchase Exemption from SPO Price or Vendor List Contract as a template to record and file requests. Form SPO-005 may be edited to meet the specific department needs. SPO forms are available on the SPO website at http://spo.hawaii.gov. Click on Forms from the home page.

VARIOUS STATE FORMS AND SPO PL CONTRACT NO 19-01 NON-PRINTED CARBONLESS PAPER 3 ORDER DEADLINE DATE: 4/15/2019

When the price list contract is not used, agencies shall purchase using the applicable procurement method and its procedures, such as small purchases or Competitive Sealed Bidding. All approvals shall be made prior to purchase. Purchases made after-the-fact, without prior approval, shall be processed as procurement violations through the form SPO-016, Procurement Violation: Report of Findings and Corrective Action and/or Request for After-the-Fact Payment Approval. POINTS OF CONTACT. Questions regarding the products listed, ordering, pricing, and status should be directed to the Contractor. Procurement questions or concerns may be directed as follows: Jurisdiction Name Phone Fax E-mail Executive Lori Cervantes 587-3355 586-0570 lori.m.cervantes@hawaii.gov

HHSC Jeff Dansdill 657-3721 jedansdill@hhsc.org

OHA Phyllis Ono-Evangelista 594-1833 594-1865 phylliso@oha.org

House Brian Takeshita 586-6423 586-6401 takeshita@capitol.hawaii.gov

Senate Carol Taniguchi 586-6720 586-6719 c.taniguchi@capitol.hawaii.gov

Judiciary Tritia Cruz 538-5805 538-5802 tritia.l.cruz@courts.hawaii.gov CONTRACTOR. Pacific Business Forms, Inc. is authorized to provide Various State Forms and Non-Printed Carbonless Paper for Group A – Standard Snap-Out Forms and Group B – SAF C-03 Requisition and PO Form to the State of Hawaii.

VENDOR CODES for annotation on purchase orders are obtainable from the Alphabetical Vendor Edit Table Report available at your department’s fiscal office. Agencies are cautioned that the remittance address on an invoice may be different from the address of the vendor code annotated on the purchase order. COMPLIANCE PURSUANT TO HRS §103D-310(c). Prior to awarding this contract, the SPO verified compliance of the Contractor named in the SPO Price List Contract No. 19-01. No further compliance verification is required prior to issuing a contract, purchase order of pard payment when utilizing this contract. PURCHASING CARD (pCard). The State of Hawaii Purchasing Card (pCard) is required to be used by the Executive departments/agencies, excluding HHSC, for orders totaling less than $2,500. For purchases $2,500 or more, agencies may use the pCard, subject to its credit limit, or issue a purchase order. PURCHASE ORDERS may be issued for purchases $2,500 or more and for Contractors who either do not accept the pCard, set minimum order requirements before accepting the pCard for payment or who charge its customers a transaction fee for the usage.

VARIOUS STATE FORMS AND SPO PL CONTRACT NO 19-01 NON-PRINTED CARBONLESS PAPER 4 ORDER DEADLINE DATE: 4/15/2019

SPO PL CONTRACT NO. 19-01 will be typed on purchase orders issued against this price list contract. For pCard purchases, the SPO PL Contract No. 19-01 shall be notated on the appropriate transaction document. PAYMENTS are to be made to the remittance address of the Contractor(s). HRS §103-10, HRS, provides that the State shall have thirty (30) calendar days after receipt of invoice or satisfactory completion of the contract to make payment. VENDOR AND PRODUCT EVALUATION. Form SPO-012, Evaluation: Vendor or Product, for the purpose of addressing concerns about this price list contract, is available to the agencies at the SPO website: http://spo.hawaii.gov. Click on Forms on the home page. PRICE OR VENDOR LIST CONTRACT AVAILABLE ON THE INTERNET at the SPO website: http://spo.hawaii.gov. Click on Price & Vendor List Contracts on the home page.

VARIOUS STATE FORMS AND SPO PL CONTRACT NO 19-01 NON-PRINTED CARBONLESS PAPER 5 ORDER DEADLINE DATE: 4/15/2019

CONTRACTOR INFORMATION

For Group A – Standard Snap-Out Forms and Group B – SAF C-03 Requisition and PO Form Contractor: Pacific Business Forms, Inc. Contact Information:

Name: Jon Vasquez Phone: (808) 597-1717, ex 31

Fax: (877) 837-1469 E-mail: pacificbf@gosafeguard.com

Correspondence & Remittance Address:

Pacific Business Forms, Inc. 2958 Ualena Street, Suite A Honolulu, HI 96819

MINIMUM ORDERS REQUIREMENTS Group A - Various Standard Snap-Out Forms. The minimum order on each order shall be $20.00 (excluding the GET) or the total order for Agencies whose total requirements total less than $20.00. Agencies are requested to place a minimum order of 5 books when ordering SAF B-24 (all parts). Orders shall be placed in increments of 100 sets per pack or for SAF B-24, 50 sets per book. Group B - Requisition and PO Forms. For snap-out forms, orders shall be placed in increments of 100 forms per set. For continuous forms, the minimum order is 1000 sets. When ordering SAF C-03, Agencies are requested to submit a completed Attachment 1 with orders.

VARIOUS STATE FORMS AND SPO PL CONTRACT NO 19-01 NON-PRINTED CARBONLESS PAPER 6 ORDER DEADLINE DATE: 4/15/2019

ORDERING INSTRUCTIONS ORDERING on a timely basis is the responsibility of each agency. All orders shall be placed with the Contractor by April 15, 2018. The Contractor is not obligated to accept any order received after the deadline date. The Contractor shall honor all orders received by the deadline date and delivered by the delivery deadline. At the time of order, agencies are requested to specify imprinting and pre-numbering requirements, if applicable, and the exact delivery address. Agencies shall not issue purchase orders specifying delivery after the delivery deadline date. Attachment 2, Agency Requirements, lists requirements submitted in response to SPO Circular No. C19-01 dated September 28, 2018. For all forms, requirements may be increased but not decreased at the time of ordering. For non-printed carbonless paper, the requirements remain firm and shall not be increased or decreased. Agencies not listed in Attachment 2 are allowed to order forms from Group A, Various Standard Snap-Out Forms and Group B, Requisition and PO Forms on or before the order deadline date.

UNIT PRICES include delivery to destination and all other costs except the State General Excise Tax (GET), currently 4.5% for transactions made on the islands of Oahu and Kauai, 4.25% for transactions made on the island of Hawaii, and 4% for transactions made on the islands of Maui, Molokai and Lanai. Agencies should check with the contractor(s) if they will be charging the new rates (for islands of Hawaii and Kauai) and agencies are advised to add the tax amount to their purchase order total. GET shall not be applied to delivery charges. IMPRINTING AND PRE-NUMBERING CHARGES. For SAF C-03, Requisition and PO Forms, imprinting and pre-numbering charges are included in the unit price. Agencies are requested to submit Attachment 1, SAF C-03 Order Form, with their order indicating the exact imprinting and pre-numbering information required for each order of SAF C-03 forms. DELIVERIES by the Contractor shall be made on or before June 15, 2019. The exact delivery address shall be provided by the individual agency when placing an order. If the delivery address is not indicated on order, Contractor shall contact the appropriate agency, prior to shipment and coordinate delivery arrangements. The Contractor shall deliver the exact amount ordered to the address stated on the order form; no overruns or underruns will be accepted. The State will not pay for any overruns that the Contractor may deliver. INSPECTION. Agencies are advised to inspect merchandise delivered immediately upon receipt and report any discrepancies to the vendor within five (5) working days from the delivery date. ATTACHMENT 1-SAF C-03 Order Form ATTACHMENT 2-Agency Requirements

VARIOUS STATE FORMS AND NON-PRINTED CARBONLESS PAPER 7

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019

GROUP A - VARIOUS STANDARD SNAP-OUT FORMS

Item No. Form No. Title Vendor

1 SAF B-14 Treasury Deposit Receipt (cont), 4-part $55.17 /pack Pacific Business Forms, Inc.

2a SAF B-24 Official Receipt Book, 2-parts (50 sets/book) $10.81 /book Pacific Business

Forms, Inc.

2b SAF B-24 Official Receipt Book, 3-parts (50 sets/book) $7.59 /book Pacific Business

Forms, Inc.

2c SAF B-24 Official Receipt Book, 4-parts (50 sets/book) $15.43 /book Pacific Business

Forms, Inc.

3 SAF C-04 Requisition and Purchase Order, Continuation, (2nd page), 7-part $276.00 /pack Pacific Business

Forms, Inc.

4a SAF D-55 Individual Time Sheet, 3-part $15.25 /pack Pacific Business Forms, Inc.

4b SAF D-55 Individual Time Sheet, 4-part $17.69 /pack Pacific Business Forms, Inc.

5 SAF D-56 Organizational Time Sheet, 3-part $82.50 /pack Pacific Business Forms, Inc.

6 SAF D-60 Salary Assignment/Cancellation, 4-part $97.07 /pack Pacific Business Forms, Inc.

7 SAF D-62 Motor Vehicle Insurance Deduction Authorization, 4-part $250.00 /pack Pacific Business

Forms, Inc.

8 SAF D-70 Notification for Payroll Adjustment, 4-part $286.70 /pack Pacific Business

Forms, Inc.

9 G-2Application for Transfer of Vacation and Sick Leave Credit or Payment in Lieu of Vacation, 5-part

$40.36 /pack Pacific Business Forms, Inc.

10 HRD-10 Notification of Temporary Assignment, 4-part $29.46 /pack Pacific Business

Forms, Inc.

11 HRD-305 Certification Form, 4-part $250.00 /pack Pacific Business Forms, Inc.

Packaging: 100 forms/pack; 50 forms/bookQuantities are firm commitments. Agencies can increase their order quantity.SAF B-24 Unit Price does not include Imprinting & Pre-numbering

Unit Price

VARIOUS STATE FORMS AND NON-PRINTED CARBONLESS PAPER 8

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019

GROUP B - SAF C-03 REQUISITION AND PO FORMS

Item No. Form No. Title Vendor

Snap-Out, Single Form, Carbonless

12 SAF C-03 Requisition & PO, 4-part $94.87 /set Pacific Business Forms, Inc.

13 SAF C-03 Requisition & PO, 5-part $42.06 /set Pacific Business Forms, Inc.

14 SAF C-03 Requisition & PO, 6-part $48.90 /set Pacific Business Forms, Inc.

15 SAF C-03 Requisition & PO, 7-part $38.58 /set Pacific Business Forms, Inc.

16 SAF C-03 Requisition & PO, 4-part $489.24 /M Pacific Business Forms, Inc.

17 SAF C-03 Requisition & PO, 5-part $478.17 /M Pacific Business Forms, Inc.

18 SAF C-03 Requisition & PO, 6-part $286.20 /M Pacific Business Forms, Inc.

19 SAF C-03 Requisition & PO, 7-part $319.61 /M Pacific Business Forms, Inc.

Imprinting and Pre-Numbering

$120.00

$30.00

Packaging: Snap-Out-100 forms/set (st); Continuous: minimum order is 1000 sets. /M = per thousandQuantities are firm commitments. Agencies can increase their order quantity.Agencies are requested to submit Attachment 1 when ordering SAF C-03.

Unit Price

Continuous Form, Carbonless

IMPRINTING charge

PRE-NUMBERING charge

Imprinting and/or pre-numbering charges are a one-time, flat-rate charge. When requesting for imprinting and/or pre-numbering, Agencies must add the applicable amount to their order.

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CONSOLIDATED REQUIREMENTS Various State Forms Non-Printed Carbonless Paper

Calendar Year 2019

Island Key 1 2a 2b 2c 3 4a 4b 5 6 7 8 9 10 11O=Oahu L=Lanai H=Hawaii V=Various M=Maui K=Kauai

B-144-part

B-242-part

B-243-part

B-244-part

C-047-part

D-553-part

D-554-part

D-563-part

D-604-part

D-624-part

D-704-part

G-25-part

HRD-10

4-part

HRD-305

4-part

Isla

nd AGENCY / DIVISION / PROGRAM CONTACT NAME

O ATG/CSEA Carol Yasaka 10O Attorney General/ASO Kapiolani Teves 2O DAGS/Archives MaryJane Tadena-Hart 6 √O DAGS/AMD Richard Hung 12 √ √O DAGS/CSD Zayna Sakuma 5O DAGS/ETS Susan Maracle-Sweeney 2O DAGS/Personnel Jody Taira 2O DAGS/PWD Shari Lee 3K DAGS/KDO Karene Kawamoto 2 2 2O DAGS/Stadium Isabelle Nishimoto 5 √ 2O FMO/ACCTG/PAS II Phyllis Uyehara 5 √ √O DIR Cyndi Vallente 1O DVR Anita Santiago 1 1 1O MQD Kathy Ann Keawe 1O SSD/APCSB/OAPCSS/APCS2 Ono Fualau-Soon 1O SSD/CWSB Elizabeth Asuega 15 1 1O DVR/SSB/HOOPONO Geri Mitomi 2O SSD/CWSB Grace Oba 6 2O SSD/CWSB Katelyn Coon 2 1 1H SSD Geri Santana 1 1H SSD/CWSB/EHCWSS Sheryl Medeiros 6K SSD/CWSB/KauaiCWSS Kathyrn Brier 10 10M SSD/CWSB/MCWSS Lynn Barut 1 2O DLIR/Disability Compensation Div Royden Koito 1 1M DLIR/Disability Compensation Div/Maui Sharon Shar 1 1 1 1 1O DLIR/Personnel Ian Greene 1 3K DLIR/WDD-Kauai Casey Rabot 1O DLIR/HIOSH Deirdre Yamasaki 20 √ √O DLIR/WDD-Adm Joyce Suganuma O DLIR/UI-Adm Cindy Yoshida 1O DLNR/ENGINEERING Alyson Yim 2 1O DLNR/STATE PARKS Piikea Tomczyk 17 1 1O DLNR/DOCARE Norine Oyasato 100M DLNR/LAND Juergen Gross 1M DLNR/KIRC Ka'onohi Lee 2 1O DLNR/DOBOR Jackie Velasco 2K DLNR/DOBOR Florence Rasay 1 1 1O DLNR/DOFAW Michelle Del Rosario 2O Defense/ASO/SFO Dorothea Cantero 10 √ √ 3

GROUP A - Various Standard Snap-Out FormsBid Item No.

B-24

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B-24

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SAF Form No. No. of Parts:

ATTACHMENT 2AGENCY REQUIREMENTS A2-1

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019

CONSOLIDATED REQUIREMENTS Various State Forms Non-Printed Carbonless Paper

Calendar Year 2019

Island Key 1 2a 2b 2c 3 4a 4b 5 6 7 8 9 10 11O=Oahu L=Lanai H=Hawaii V=Various M=Maui K=Kauai

B-144-part

B-242-part

B-243-part

B-244-part

C-047-part

D-553-part

D-554-part

D-563-part

D-604-part

D-624-part

D-704-part

G-25-part

HRD-10

4-part

HRD-305

4-part

Isla

nd AGENCY / DIVISION / PROGRAM CONTACT NAME

O Defense/Admin/State Personnel Office Dorothea Cantero 10O Defense/HIEMA Evelyn Kobayashi 12O Health/FHSD/Maternal & Child Health Estrella Vega 1 √ 1 1 1 1 3 5O Healtlh/FHSD/CSHNB/EIS Amy Rivera 1O Health/CDPHPD/CDMB Iris Okumura 1 √ √ 2O Health/CDPHD Iris Okumura 1 3O Health/State Laboratories Division Elsie Cristobal 4 3O Health/BHA/OPIE Cara Okuda 1O Health/EHA/EHSD/EMD Sheryl Kajiyama 2 61 √ 11O Health/AMHD/HSH Anthony Fraiola 20 20O Health/DDD/CMB Jay Ulmer 2O Health/CDPHPD Mahealani Kaonohi 2 √ √ 5O Health/CAMHD Mike Mason 20O Health/Kauai District Health Office Jackie Teves 3O Health/Hawaii District Health Office Lisa Koike-Enriques 4 2 2O Health/DOCD/ Corliss Yoshiura 2 2 4O Health/ASO/FISCAL Iris Quinto 5O Health/ADAD Esteban Villarino 1 √O Health/Health Status Monitoring Kananipuakea Kaina 5 √ √O DOTAX.ASO Les Inouye 100 √ √O JUD/FC1/FISCAL Reinalda Trinidad 1O JUD/Ewa Court Karen R. Suzuki 4O JUD/ Kaneohe Court Lucila Duarte 10O JUD/ IT & Systems Dept Minda Abad 1O JUD/CC1/FISCAL Elsa Ornellas/Sandy Togawa 25 4H THIRD JUDICIAL CIRCUIT Colin Young 1K JUD/FISCAL Shirely Moriguchi 8O PSD/Admin/Fiscal Marie Miyahara 3O PSD/Health Care Lauren Gibson 33O PSD/Narcotics Iris Akamine 20O PSD/Inspections and Investigations Jan Medeiros 1O PSD/CPS - Substance Abuse Karen Corpuz 11O PSD/CPS - Education Valerie Nakamura 10O PSD/CPS - Library Terrilynn Reyes 10O PSD/CPS - Food Service Shae-Lynn Bee 20O PSD/HCF Theo Leatumauga 165 5 2 10O PSD/WCF Marivic Dar 20O PSD/SD - Airport Tracy Kobashigawa 40O PSD/Correctional Industries Walter Zaharevitz 3O PSD/TSD Blanche Isaki 4

Bid Item No.

B-24

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B-24

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SAF Form No. No. of Parts:

ATTACHMENT 2AGENCY REQUIREMENTS A2-2

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019

CONSOLIDATED REQUIREMENTS Various State Forms Non-Printed Carbonless Paper

Calendar Year 2019

Island Key 1 2a 2b 2c 3 4a 4b 5 6 7 8 9 10 11O=Oahu L=Lanai H=Hawaii V=Various M=Maui K=Kauai

B-144-part

B-242-part

B-243-part

B-244-part

C-047-part

D-553-part

D-554-part

D-563-part

D-604-part

D-624-part

D-704-part

G-25-part

HRD-10

4-part

HRD-305

4-part

Isla

nd AGENCY / DIVISION / PROGRAM CONTACT NAME

H PSD/HCCC Tessie Brown 2 10 100 30H PSD/KCF Pattie Jo 20 15M PSD/MCCC Laverne Bednorz 48K PSD/KCCC Darlene Agustin 30 20K DOT/Harbors/Kauai Annabelle Clark 20 12 10M DOT/Harbors/Maui Brandie Shimabukuro 20 10 1 2O DOT/Harbors/Fiscal Aurora Bigelow 5 1O DOT/Harbors/Oahu David Lee 4 2O DOT/Harbors/Personnel Joyce Kaneshiro 5O DOT/Harbors/Staff Janice Otaguro 1H DOT/Harbors/Hawaii Ana Marie Aiu 2

14 43 138 80 0 119 456 6 6 0 1 25 113 00 3 10 0 0 20 108 0 0 0 0 0 47 00 0 21 0 1 50 10 0 1 0 1 4 5 00 20 30 0 0 0 53 0 0 0 0 3 24 00 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 014 66 199 80 1 189 627 6 7 0 2 32 189 0

pks bks bks bks pks pks pks pks pks pks pks pks pks pks

Bid Item No.

B-24

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SAF Form No. No. of Parts:

GROUP A - Total by Island:Oahu

HawaiiMaui

KauaiLanai

MolokaiGROUP A - TOTAL ALL ISLANDS

The above represents the departments minimum requirements for Snap-out (multiple part) Standard Forms for agencies/divisions/programs on the island(s) specified above.

ATTACHMENT 2AGENCY REQUIREMENTS A2-3

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019

CONSOLIDATED REQUIREMENTS Various State Forms Non-Printed Carbonless Paper

Calendar Year 2019

12 13 14 15 16 17 18 19

C-034 part

C-035 part

C-036 part

C-037 part

C-034 part

C-035 part

C-036 part

C-037 part pr

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AGENCY / DIVISION / PROGRAM CONTACT NAME

O DAGS/ASO- Risk Tracy Kitaoka 5H DAGS/HDO Elise Nakamoto 10,000 √K DAGS/KDO Karene Kawamoto 2000 √M DAGS/MDO Sharlene Hashimoto 4000O DAGS/Stadium Isabelle Nishimoto 3000O DHHL/Fiscal Office Christe Lum 6000O SSD/CWSB/OCQSS1-OCWSI1 (08) Elizabeth Asuega 7 √ √O SSD/CWSB Grace Oba 6 √H SSD/CWSB/EHCWSS Sheryl Medeiros 19 √ √K SSD/CWSB/KauaiCWSS Kathyrn Brier 10 10 √ √O DLNR/ENGINEERING Alyson Yim 4O DLNR/OCCL Sharleen Kuba 1O DLNR/AQUATICS Kelly Yoshizaki 2000O DLNR/DOCARE Norine Oyasato 10 1000 √ √O DLNR/DOCARE Mari Koyama 5000 √M DLNR/DOCARE Mona-Lisa Castardo 1000 √K DLNR/DOCARE Norine Oyasato 1000 √O DLNR/LAND Juergen Gross 2 2000K DLNR/LAND Juergen Gross 2M DLNR/LAND Juergen Gross 2O DLNR/DOBOR Jackie Velasco 25 √O DOA/ASO/FISCAL Kimberli Hayashi 4000 √O DEFENSE/HIARNG/ENV Pamela Divine 4O DEFENSE/HIEMA Evelyn Kobayashi 2000O DEFENSE/HIARNG/FMO James Nakaminie 20O PSD/Mainland Branch Kim Castanares 5000O PSD/Admin/Fiscal Marie Miyahara 15000O PSD/CPS - Food Service Shae-Lynn Bee 10O PSD/OCCC Nyrie Salcedo 4000O PSD/OISC Merlene Wong 1000H PSD/HCCC Tessie Brown 10000M PSD/MCCC Bridgette Adric 1000K PSD/KISC Margaret Pelegrino 1000O LEGISLATURE/SENATE Deborah Aki 10 √ √K DOT/Harbors/Kauai Annabelle Clark 10 √ √M DOT/Harbors/Maui Brandie Shimabukuro 5 √ √

GROUP B - Total by Island 10 12 6 76 3000 4000 11000 320000 19 0 0 0 0 10000 100000 0 5 2 0 0 4000 20000 0 20 12 0 0 2000 200010 31 31 90 3000 4000 27000 46000

The above represents the departments minimum requirements for Snap-out (multiple part) Standard Forms for agencies/divisions/programs on the island(s) specified above. GROUP B - TOTAL ALL ISLANDS

Bid Item No. est. imprint /pre-# rqmts

Part: PART I: Snap-Out, Single Sets PART II: Continuous

GROUP B - SAF C-03 Requisition and PO Form

SAF Form No. No. of Parts:

OahuHawaii

MauiKauai

ATTACHMENT 2AGENCY REQUIREMENTS A2-4

SPO PL CONTRACT NO. 19-01ORDER DEADLINE DATE: 4/15/2019