Sample Contract Exhibit A OFFICE OF CONTRACT CTORJ

Exhibit A -- Sample Contract

OFFICE OF CONTRACT

CTORJ

Exhibit A -- Sample Contract

This Contract, executed and entered into as of this

of

, 2017, by

and between, the Office of Hawaiian Affairs ("OHA"), a body corporate under the Constitution

of State of Hawai'i, by its Ka Pouhana, Chief Executive Officer ("CEO") and Head of

Procurement Agency ("HOPA"), pursuant to the Chief Procurement Officer Delegation of

Authority and Revised Operational Authority Delegation Hierarchy datedFebniary 9, 2017,

acting by and on behalf of the Board of Trustees, whose principal place of business and mailing

address is 560 North Nimitz Highway Suite 200 Honolulu Hawai 1 96817, and [NAME OF

CONTRACTOR] ("CONTRACTOR"), a [Type of Busi i'e. Sole Proprietor, Linited

Liability Partnership/Corporation, Son-Profit], by j?i 4sition e Executive Director], whose

ii

/

//

iP47

principal place of business and mailing

Addr, [City], Hawai'i [Zip

Code], Sole Proprietor's Social Security

federal Tax ID No. L_-

]?

XX-XX.f -- _]; LLP/CfNon or For-Profit

\ `.c_-_ ES$E TH

WHEREASone of the purp?es for hith the OHA has been established is to better the

conditions of Hawaiiia&aefined in Secjc? 10-2, Hawai'i Revised Statutes ("HRS"); and

WFilREAS, the F1A was ,talished to better the conditions of native Hawauans and

Hawaansasdefidin Haai'i Revised Statues (`HRS') Sections 10-2, 10-4(4), 10-4(6) and

1 0-4(8derap1iabfe law(s), as amended; and

WHET S_e expenditure of funds as proposed in this Contract are intended for the

betterment of conditions of native Hawaiians and Hawaiians as set forth in Section 10-3(1) and

(2), HRS and is consistent with the purpose for which these funds were appropriated; and

WHEREAS, the OHA is in need of [Description of PR];and

OHA and NAME OF CONTRACTORI

Page I of 7

Exhibit A -- Sample Contract WHEREAS, the OHA has awarded this Contract through competitive sealed proposals submitted for [Solicitation No.] pursuant to Hawai'i Revised Statutes as amended and its companion Hawai'i Administrative Rules; and

WHEREAS, the CONTRACTOR has been evaluated as a responsible and responsive

/

Offeror whose proposal is advantageous for the OHA. such evaluation factQria apacity,

qualifications and resources to perform the terms and conditions agreedt?pnder this Qontract

`;

...

NOW, THEREFORE, the parties hereto mutually agree as follows

I Scope of Services The CONTRACTOR4 II, ma proper and satisfatory

manner as determined by the OHA, provide all t erg. SI which is hereby made a part of this Contract.

U s?iices set forifrin Attachment --

2. Time of Performance. Th

orman

uired of the CONTRACTOR under

this Contract shall be completed in accordahce `with the tim. chedule set forth in Attachment --

S2 which is hereby made a

biI6ontrat.

3 Compensation The ?ONRAUOR shall be compensated according to the

Compensation provis net1'ortbinAttacbiijent -- 53 which is hereby made a part of this

Contract. c

4. Standards o

onduct Declaration. The Standards of Conduct Declaration of the

CON

R is afl ed is made a part of this Contract.

5. .

CTOR's Acknowledgment Statement. The CONTRACTOR's

Acknowledgment Statement is attached and is made a part of this Contract.

6. Other Terms and Conditions. The General Conditions and any Special

Conditions are attached hereto and made a part of this Contract. In the event of a conflict

O)IA and jNAIE OF CONTRACTOR)

Page 2 of?

Exhibit A -- Sample Contract

between the General Conditions and the Special Conditions, the Special Conditions shalt control. 7. Notices. Any written notice required to be given by any party to this

Contract shall be (a) delivered personally, or (b) sent by United States first class mail, postage prepaid. Notice required to be given to the CEO shall be sent to the CEO's business and mailing

address as set forth in the first paragraph of this Contract. Notice to the GONTRACTOR shall be

sent to the CONTRACTOR's business and mailing address as set

of

this Contract. A notice shall be deemed to have been received THREE (3) d4maili-ig or

at the time or actual receipt whichever is earlier. The C

CTOR is resnonsib ? for

notifying the OHA in writing of any change of ad.

8. Counterpart Execution. The @CO'RACT Riee that this

Agreement may be executed in counterp ach of shall be deemed an original

regardless of the date of its execution and v 11 such unterparts together shall constitute

one and the same documen.

urtr agre accept facsimile executed documents as

if they were origina ly signed docum s and su facsimile signatures shall be deemed to be

original and effective

arties. e party submitting the facsimile signature shall

provide theoter party

rigina 1 signed replacement documents within FIVE (5) business

days m the date frecei by the other party of the facsimile executed documents.

THIS SPACE INTENTIONALLY LEFT BLANK

OHA and )NAME OF CONTRACTOR)

Page 3 of 7

Exhibit A -- Sample Contract COUNTERPART EXECUTION

IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective as of the date first above written.

OFFICE Of HAWAIIAN

Date:

.2017

APPROVED AS TO FORM:

Bi ALBERT TIBERI Its Ka Paepae Puka, Senior Lej

Date:

THIS SPACE LEFT INTENTIONALLY BLANK

OHA and NAME OF CONTRACTORI

Page 3 017

Exhibit A -- Sample Contract COUNTERPART EXECUTION

IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective as of the date first above written.

[NAME OF CONTRACTOR]

Date:

2017

By

OIJA nd NAME OF CONTRACTORI

Page 5 of 7

Exhibit A -- Sample Contract CONTRACTOR'S ACKNOWLEDGMENT

STATE Of HAWAI'I CITY AND COUNTY Of

)

) SS.

)

Jfr4%

On this

day of

, 2017, before me persol1y appered [NAME

Of SIGNING AUTHORITY], to me personally known, who, being dulom, did say

that such person is the [Position] of [NAME Of CONTRACTOR], the CO.

CTOR;named

in the foregoing instrument, and that he/she/they is/are authrized to sign sai trume on

behalf of the CONTRACTOR, and acknowledges that he the/they executed sai

ent as

the free act and deed of the CONTRACTOR.

(Oflicial Stamp or Seal)

(NzY signai

sry

1' . :jrint nameNotary Public, State of Hawari

\` M. ``?..\ mmissio,p expires.

NOTARY CERTIFICATION ST Document Identificaecription.

%&

D Doc Date: No. of

OR

T Jurisdiction:

U Undated at time of notarization

Circuit (in which notary act is performed)

Signature of Notary

Date of notarization

Printed Name of Notary

(C) Tic al Stanip or

OHA and jNAIEOF CONTRACTORI

Page 6 017

Exhibit A -- Sample Contract

STANDARDS OF CONDUCT DECLARATION

For the purposes of th is declaration: *"controlling interest" means an interest in a business or other undertaking which is sufficient in fact to control, whether the interest is greater or less than fifty percent (50%). "Employee" means any nominated, appointed, or elected officer or employee of the State or OHA, including members of boards, commissions, and committees, and employees under contract'to the State or of the constitutional convention, but excluding legislators, delegates to the constitutional convedt1?justices, and judges. On behalfofiNAME OF CONTRACTORI, CONTRACTOR, the undersigned does 1are, under penalty of perjury, as follows:

I.

CONTRACTOR (is) (is not) a legislator or an employee or a busine

an employee has a controlling interest.*

/7 `hich a le1ator or

2.

CONTRACTOR has not been assisted or represerite

legislator or ethploye,. or a fee or other

compensation to obtain this Agreement and will not be assisted eprese

a legislatoir employee for a fee

or other compensation in the performance of the Agreemen

slator or loyee a8been involved in the

development or award of the Agreement.

3.

CONTRACTOR has not been a ted or

e for a fee orher compensation in the award

of this Agreement by a State or OHA employee

the case

Legislature, by a legislator.

4.

CONTRACTOR has not been re e U or assis

nally on matters related to the

Agreement by a person who has been an employee th e or OH hin the preceding two (2) years and who

participated while in state office or oyment on t ma ith which the Agreement is directly concerned.

5.

CONTRACTOR has t

ed or isted on matters related to this Agreement, for a

fee or other consideration by an individua ho,

past twelve (12) months, has been a State or 01-IA

employee, or in the casof the Legislature, a islator.

6. other consideration by an or in the casef the Legi to this

not been r nted or assisted in the award of this Agreement for a fee or past twelve (12) months, served as a State or OHA employee

) participated while an employee or legislator on matters related

of the violation of the

that the Agreement to which this document is attached is voidable on behalf was entered into in violation of any provision of chapter 84, Hawaii Revised Code of Ethics, including the provisions which are the source of the

Ily, any fee, compensation, gift, or profit received by any person as a result of a :s may be recovered by the State or OHA.

CONTRACTOR

OHA and lNAvIE OF CONTRACTORI

Title: Date:

Page 7 of 7

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