State of Hawaii Supplier Paperwork 2021

 
1.  Do not submit your form until it is completed
2.  Sign both signature pages of the Supplier Agreement.
3.  Please pay close attention to the requirements in the policies and procedures.
4.  Please verify your insurance requireements are accurate before  submission and the certificate holder section is completed:
Covendis/State of Hawaii
200 Walker Street SW, Suite B
Atlanta, GA 30313
 
 
Please submit any questions to customercare@covendis.com.

POLICIES & PROCEDURES

Below are the Policies & Procedures for all states. This document includes rules and best practices along with insurance requirements. It is in your best interest to familiarize yourself with the content of this document. 

Company Information

Does your company have a different remittance address? *
Business Description (Select the appropriate description for your business) *
Are you currently offering minimum healthcare coverage to all workers as per the Affordable Care Act? If the answer is "No" to this question, please provide additional details below on why you are not currently offering minimum healthcare benefits to your workers as per the Affordable Care Act. *

Business Classifications

Federal Business Classifications
Identify which business certifications apply.
A CERTIFICATE MUST BE ATTACHED FOR THE CLASSIFICATIONS YOU SELECT
If additional information is needed, please visit www.sba.gov
 
Small Disadvantaged Business (SDB) - No certificate required *
8(a) *

HUBZone *

Service-Disabled Veteran Owned Small Business (SDVOSB) *

Women-Owned Small Business (WOSB) *

National Business Classification
Identify which business certifications apply.
A CERTIFICATE MUST BE ATTACHED FOR THE CLASSIFICATIONS YOU SELECT
If more information is needed, please visit www.nmsdc.org or www.wbenc.org
National Minority Supplier Development Council (NMSDC) *

Women's Business Enterprise National Council (WBENC) *

General Documents


Do you currently have active contractors working at the State of Hawaii? *

State of Hawaii

Are you currently a supplier for the State of Hawaii? *


Signature and Confirmation

I certify all information in this renewal is complete and accurate. *
clear
Do you need a countersigned copy of your agreement(s)? *

Save & Return

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