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Bid Zip RFP #4574/TabulationByVendor_RFP#4574.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Penn Hawaii Youth Foundation Page of 1 26 General Comments: Thank you for opening up
this funding. Please reach out to myself or Becky Brett, our grant writer (276) 451-8360, if there are any questions. Mahalo nui loa. General Attachments: PHYF Application doc.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Hawaii Institute of Pacific Agriculture Page of 2 26 General Comments: General Attachments:
Attachment A. Proposal Application Checklist.pdf Attachment B. Proposal Application Form.pdf Attachment C. Proposal.pdf Attachment D. Line-Item Budget.pdf Attachment E. 2022 Profit
and Loss Statement.pdf Attachment F. 2023 Profit and Loss Statement.pdf Attachment G. 2022 Balance Sheet.pdf Attachment H. 2022 Balance Sheet.pdf Attachment I. 2020 Form 990.pdf Attachment
J. 2021 Form 990.pdf Attachment K. 2022 Form 990.pdf Attachment L. 2023 Approved Operating Budget.pdf Attachment M. 2024 Approved Operating Budget.pdf.pdf Attachment N. Certificate
of Good Standing from the State of Hawaii DCCA.pdf Attachment O. Federal Certification.pdf Attachment P. Unredacted Electric Copy of Proposal.pdf Attachment Q. Redacted Electric Copy
of Proposal.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Hilo Beauty College LLC Page of 3 26 General Comments: General Attachments:
Appendix 1 signature.pdf Attachment A Hilo Beauty College (fixed).pdf Attachment B Hilo Beauty College LLC (fixed).pdf certificate Hilo Beauty.pdf Hilo Beauty College LLC RFP 4574.pdf
Hilo beauty College LLC.xlsx redacted 2022 tax return new.pdf redacted 2022 tax return RE.pdf Unredacted 2022 Tax Return RE.pdf unredacted 2023 new.pdf unredacted 2023 tax return part
2 A.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Kirpal Meditation and Ecological Center Page of 4 26 General Comments: Aloha,
Enclosed each individual attachment, the unredacted proposal, and the redacted proposal (w-o annexes and attachments). Feel free to let us know if you require additional information
or documentation. Thank you for your time and consideration. Mahalo, KMEC Hawaii General Attachments: KMEC - Attachment A.pdf KMEC - Attachment B.pdf KMEC - Attachment C.pdf KMEC -
Attachment D.pdf KMEC - Attachment E.pdf KMEC - Attachment F.pdf KMEC Proposal - RFP No 4574 (Redacted).pdf KMEC Proposal - RFP No 4574 (Unredacted).pdf County of Hawaii Tabulation
Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Rock Star Pets Hawaii LLC Page of 5 26 General Comments: General Attachments: RSPH Proposal Application SLFRF
RFP #4574.pdf RSPH Proposal Application SLFRF RFP #4574_Redacted.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: The Island of
Hawaii YMCA Page of 6 26 General Comments: The Island of Hawaii YMCA did not submit the General Terms and Conditions for Goods and Services with this application. The YMCA is prepared
to comply with any requirements set forth by the County should we be a recipient of this RFP. Thank you very much! General Attachments: 2024-04-29 YMCA Final Application RFP 4574.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Cupcakes BOOM Page of 7 26 General Comments: General Attachments: APPENDIX I TO ATTACHMENT
F FEDERAL TERMS AND CONDITIONS (1).pdf ATTACHMENT F- FEDERAL TERMS AND CONDITIONS (1).pdf COH Grant Proposal.pdf COH Grant Proposal REDACTED.pdf County of Hawaii Tabulation Report
RFP #4574 - Small Business Economic Recovery & Support Vendor: 75 Degrees Cafe LLC Page of 8 26 General Comments: General Attachments: 75 Degrees Cafe.xlsx 75 Degrees LLC RFP 4574.pdf
Attachment A 75 Degrees Cafe LLC (fixed).pdf Attachment B 75 Degrees Cafe LLC (fixed).pdf certificate 75.pdf redacted 2022 tax return new.pdf redacted 2022 tax return RE.pdf redacted
2023 new.pdf Unredacted 2022 Tax Return RE.pdf unredacted 2023 new.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Kekahu Concrete
LLC Page of 9 26 General Comments: General Attachments: Budget.xlsx Certificate of Vendor Compliance.pdf The Proposal Application.pdf County of Hawaii Tabulation Report RFP #4574
- Small Business Economic Recovery & Support Vendor: Custom made beauty LLC Page of 10 26 General Comments: General Attachments: Appendix 1 signature.pdf Attachment A Custom Made Beauty
LLC (fixed).pdf Attachment B Custom Made Beauty LLC (fixed).pdf certificate custom made.pdf Custom Made Beauty LLC RFP 4574.pdf Custom Made Beauty LLC.xlsx redacted 2022 tax return
new.pdf redacted 2022 tax return RE.pdf Unredacted 2022 Tax Return RE.pdf unredacted 2023 new.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery &
Support Vendor: Punachicks Farm, LLC Page of 11 26 General Comments: I uploaded all attachments several times in the correct order and when I login again they are in a different order,
so hoping that doesn't count against me. General Attachments: Federal Terms and Conditions.pdf Proposal Application Checklist.pdf Proposal Application Form.pdf Proposal - redacted.pdf
Proposal - unredacted.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Ruthie Moss L.Ac LLC Page of 12 26 General Comments: General
Attachments: Ruthie Moss LAc LLC - HHH Project Proposal redacted.pdf Ruthie Moss LAc LLC - HHH Project Proposal unredacted.pdf County of Hawaii Tabulation Report RFP #4574 - Small
Business Economic Recovery & Support Vendor: Arc of Hilo Page of 13 26 General Comments: Please find our proposal attached. Mahalo, Robert Efford CEO The Arc of Hilo General Attachments:
Proposal_RFP_4574_Arc of Hilo Laundry Program_Impact of COVID19_May 9_24.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Kona
Stories LLC Page of 14 26 General Comments: General Attachments: Kona Stories _APRA_ Upload.pdf Kona Stories _APRA_ Upload_Redacted.pdf County of Hawaii Tabulation Report RFP #4574
- Small Business Economic Recovery & Support Vendor: East Hawaii Cultural Council Page of 15 26 General Comments: General Attachments: EHCC_APRA_Upload File.pdf EHCC_APRA_Upload File_Redacted.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Made to Move LLC Page of 16 26 General Comments: Thank you for the opportunity to
apply for this grant. General Attachments: Final HCSB Redacted Copy of Grant.pdf Final Unredacted Copy of Grant.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic
Recovery & Support Vendor: Laupahoehoe Train Museum Page of 17 26 General Comments: Proposal Application Checklist, Form, and Federal Certification are included in the grant application
pdf. There is no redacted information so the unredacted and redated proposal pdf are identical. General Attachments: Grant application.pdf Redacted Proposal.pdf Unredacted Proposal.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Kai`Opua Canoe Club Page of 18 26 General Comments: The above General Attachments
are downloaded for RFP 4574 County of Hawai`i Bid # 185642 The applicant is nonprofit Kai`Opua Canoe Club 1. Kai`Opua Canoe Original copy 2. Kai`Opua Canoe Club -Redacted copy General
Attachments: kai opua rfp 4574.pdf redacted kai opua rfp 4574.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Device Repair Shop
LlC Page of 19 26 General Comments: Sorry, when attaching tax returns only the first page shows up so I just uploaded it separately. General Attachments: Redacted_2022_TaxReturn.pdf
Redacted_2023_TaxReturn.pdf RFPno4574Proposal.pdf RFPno4574Proposal-Redacted.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Hawaii
Red Fruits LLC Page of 20 26 General Comments: General Attachments: Appendix I signature Chanh.pdf Attachment A Hawaii Red Fruit LLC (fixed).pdf Attachment B Hawaii Red Fruit LLC (fixed).pdf
certificate redfruit.pdf Hawaii Red Fruits LLC RFP 4574.pdf Hawaii Red Fruits LLC.xlsx redacted 2022 tax return new.pdf redacted 2023 new.pdf Unredacted 2022 Tax Return RE 2.pdf Unredacted
2022 Tax Return RE.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Da Hawaiian Brain Freeze Page of 21 26 General Comments: Da
Hawaiian Brain Freeze has has uploaded the grant proposal for RFP #4574. Additional uploads included a redacted and unredacted copy General Attachments: Da Hawaiian Brain Freeze Grant
Proposal.pdf Da Hawaiian Brain Freeze Grant Proposal Redacted Copy.pdf Da Hawaiian Brain Freeze Grant Proposal Unredacted Copy.pdf County of Hawaii Tabulation Report RFP #4574 - Small
Business Economic Recovery & Support Vendor: Rainbow Medical Supply, Inc. Page of 22 26 General Comments: Please advise a status update when the bid application is in review by the
evaluation board. General Attachments: Attachment D- Line Item Budget RFP 4574_Redacted.pdf Certification of Contracts, Grants, Loans and Cooperative Agreements.pdf Rainbow Medical
Supply, Inc. 2021 1120S.pdf Rainbow Medical Supply, Inc. 2021 1120S_Redacted.pdf Rainbow Medical Supply, Inc. 2022 1120-S.pdf Rainbow Medical Supply, Inc. 2022 1120-S_Redacted.pdf RFP
4574 Complete Application packet.pdf RFP 4574 Complete Application packet_Redacted.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor:
Kumumea Page of 23 26 General Comments: General Attachments: DOC.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Starseed Ranch
LLC Page of 24 26 General Comments: General Attachments: Attachment A. Checklist.pdf Attachment B. Application Form.pdf Attachment C. Proposal_ Starseed Ranch .pdf Attachment D- Line
Item Budget_SR.pdf Attachment E. P-L 2022.Starseed.pdf Attachment F. P-L 2023 Starseed.pdf Attachment G. Balance Sheet SSR 2022.pdf Attachment H. BalanceSheet.Starseed.2023.pdf Attachment
I. starseed tax returns 2021.pdf Attachment J. 2022 Starseed Ranch tax returns.pdf Attachment K. COGS_Starseed.pdf Attachment L. Unredacted Copy of Proposal.pdf Attachment M. Redacted
Copy of Proposal.pdf Attachment N. Federal Certification APPENDIX I.pdf County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Gourmet Barn
LLC Page of 25 26 General Comments: General Attachments: 2021_TaxReturn Gourmet Barn LLC.pdf 2022_TaxReturn Gourmet Barn LLC.pdf 202405_VendorCompliance.pdf Application RFP 4574 Gourmet
Barn LLC.docx Attachment D-Line Item Budget.pdf BalanceSheetComparison 2022 - 2023.pdf ProfitandLossComparison 2022 - 2023.pdf County of Hawaii Tabulation Report RFP #4574 - Small
Business Economic Recovery & Support Vendor: Mystic Closet Page of 26 26 General Comments: GE Tax Number Attachment A Attachment B Mystic Closet Proposal Application Form Redacted
Proposal Application Form Supporting Documents- Resume Certificate of Insurance Articles of Incorporation EIN from IRS State of Hawaii Business Registration FY 2023 General Attachments:
Articles of Organization.jpeg Attachment A.pdf Attachment B.pdf Attachment D- Line Item Budget.pdf EIN from IRS.jpeg GE Tax Number.jpg Hawaii Biz Registration FY23.jpeg Insurance Retail
Store Kona.jpeg Insurance Retail Store Pahoa.jpeg Mystic Closet Proposal Application Form.pdf Redacted Proposal Application Form.pdf Tisha Montoya Resume.pdf
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/TabulationByVendor_RFP#4574_orgId_1036955.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: 75 Degrees Cafe LLC Page of 1 1 General Comments: General Attachments: 75 Degrees Cafe.xlsx
75 Degrees LLC RFP 4574.pdf Attachment A 75 Degrees Cafe LLC (fixed).pdf Attachment B 75 Degrees Cafe LLC (fixed).pdf certificate 75.pdf redacted 2022 tax return new.pdf redacted 2022
tax return RE.pdf redacted 2023 new.pdf Unredacted 2022 Tax Return RE.pdf unredacted 2023 new.pdf
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/75 Degrees Cafe.xlsx
75000
75000
30000
20000
0
10000
15000
75000
0
Revenue
Organization Funds
Expense
Salaries & Benefits
$
Services & Supplies
Other Expenses
TOTAL REVENUE
TOTAL EXPENSE
NET
Other Partner Funds*
State Funds*
Other Federal Funds*
Other Partners:
State Funding:
Federal Funding:
* Please describe any of the following:
Contracts for Service Delivery
Equipment Purchases
Contracts for Service Delivery*
Equipment Purchases*
Other Expenses*
Community Resiliency Grants Program Request Amount
County of Hawaiʻi Small Business Economic Recovery & Support Program
5.3 Attachment D: Line Item Budget
75 Degreees Cafe LLC
Community Organizations, Clubs, whole salers, Yhata, Suisan
NA
Exterminating companies,nonprofit organizations
Refrigerators, Freezers,Sandwich prep tables, ovens
Rent, renovations, Insurance, Food
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/75 Degrees LLC RFP 4574.pdf 75 Degrees LLC RFP 4574
Organization: 75 Degrees Cafe RFP No: 4574 ProposalApplicationTableofContents 3.1. EntityDescription .................................................................. 1 a. Brief Description
......................................................................... 1 b. Principal’s Statement of Qualifications............................................... 1 c. Certificate
of Good Standing .................................................................. 1 d. Community served by entity ........................................................................
1 e. Certificate of Good Standing ........................................................................... 1 3.2 COVID-19Impacts ..................................................................
................................ 1 a. Description of Economic Harm ................................................................... 2 b. (remaining items to address) ..............................
.............................................. 2 3.3. ProjectDescription .............................................................................. 3 a. Description of Project ...................
........................................................... 3 b. Response to impact of COVID-19 ............................................................... 3 c. Economic harms ...................
..........................................………………………3 3.4. CommunityBenefit ............................................................. 4 a. History of community benefits and outcomes
.............................4 b. Providing community benefits and outcomes ................................. 4 c. County benefits ...................................................................
..................4 d. Table of benefits .........................................................................................4 3.5. LeveragingPartnershipsandResources ...........................
5 a. Track record ............................................................................... 5 b. Leverage of partnerships ..................................................................
5 3.6. ManagementCapacityandMeasurableOutcomes .............................. 6 a. Experience and capacity .............................................................................
6 b. Methods of managing, implementing, measuring, and reporting .................... 6 3.7. BudgetandFinancials ............................................................. 7 a. Total
funding request .............................................................… 7 b. Budget narrative ........................................................................... 7 c.
Funds received ................................................................................ 7 d. Project timeline ................................................................................
... 7 e. Attachment D...........................................................................................7 f. Tax Returns.......................................................................
..........................7 5.0 Attachments ................................................................................................ 8 a. (List attachments, including signed
certification found in Appendix I to Attachment F) Organization: 75 Degrees Cafe RFP No: 4574 3.1EntityDescription: a. 75 Degrees was created to introduce and promote authentic Vietnamese
food to the community of Hawaii, promote more of Hawaii, while providing a place for the people to connect and enjoy a good meal, building closer relationships for families, co-worker,
friends, and business colleagues. The goal is to provide people the opportunity to receive a break from work, problems, life, and anything they need to give them time to wind down.
b. Tram Ngo is the principal responsible for 75 Degrees Cafe organizational operations and her qualifications include being the manager of multiple businesses, licensed instructor,
and a chef. c. 75 Degrees Cafe can provide dozens of jobs and opportunities for people, including, but not limited to: i. Cooking ii. Cleaning iii. Accounting iv. Food-prepping v. Packing
(of materials and supplies) vi. Supply managing d. 75 Degrees Cafe serves the entire community, including high school students, college students, teachers, county and government workers.
Many of the people within the community seek somewhere to rest and rejuvenate themselves, which is where 75 Degrees Cafe allows them to do. e. Please see attached Certificate of Good
Standing from the State of Hawaii DCCA. 1 Organization: 75 Degrees Cafe RFP No: 4574 3.2COVID-19Impacts: a. The direct impact that 75 Degrees suffered includes having insufficient funds
to pay for rent, supplies, and workers due to a major loss in revenue. 75 Degrees also suffered from credit card debts for restaurant equipment, leading behind more other bills therefore
struggling with anxiety and different challenges. The indirect impact that 75 Degrees suffered was high levels of stress and anxiety of current workers due to the COVID-19 pandemic.
75 Degrees Cafe was also unable to find workers and manage supplies due to skyrocketing food prices. Citizens were also unable to leave their homes to attend 75 Degrees Cafe, leading
to a decrease in customers, and thus, revenue. Timeundermandatedclosure: March 25, 2020 to April 30,2020 b. 75 Degrees Cafe is a small business in a Qualified Census Tract. 2 Organization:
75 Degrees Cafe RFP No: 4574 3.3ProjectDescription a. 75 Degrees Cafe is a restaurant that increases resiliency by bringing people together, providing them an ambient atmosphere to
consume food and recreate. This allows them to connect, build relationships, network, hold business meetings, and attend community support classes. 75 Degrees Cafe also trains restaurant
workers and offers job referrals, while helping people thrive mentally and financially in all professions. Henry Ford once said “Coming together is the beginning, sticking together
is progress, working together is success,” and 75 Degrees Cafe intends to prove that in its goals. It can provide community support by teaching workers culinary skills, professional
cleaning methods, food preparation, supply management, etc., generating revenue for everyone. Relief is provided by sharing the knowledge to the younger generation to serve the community,
who will eventually thrive in grocery stores, wholesalers, large corporations, and many more job opportunities. - 75 Degrees intends to connect with other businesses, community members,
government members,leaders, non-profits, Rotary clubs, and the Hawaii contractors association, to relay the importance of the food industry relations and the effects of other industries
needed in the community. 75 Degrees will be partnering up with social media, the radio, workforce development, unemployment, goodwill industries, job seekers, welfare division, etc,
to notify of hiring. - Programs and classes will be implemented to highlight the importance of the food industry, self sustainable, sanitation and culinary skills while igniting the
interest of students to become restaurant workers, accountants, packers, distributors,sales etc. - A health and food training program will be put in place partnering up with nonprofits,
the department of health and schools to train students building positive characters to prepare for the job in the food industry. - 75 Degrees will employ workers - An entrepreneurial
program will be introduced to have workers explore other avenues with food, culinary, restaurants etc. Examples include chef, sales, hostess, waiters,servers, bartenders, running a
food truck, working at resorts, accountant, customer service, distribution,wholesale, etc. - Business meetings for entrepreneurs,innovators, community leaders to connect and share ongoing
ideas to help the community thrive economically. b. This proposal directly responds to the negative impact of the COVID-19, because people need connection, guidance, and hope to thrive.
With enough support, it will inspire people to take action. The more action taken, the more jobs will be produced with more opportunities and tax revenue generated. 3 Organization:
75 Degrees Cafe RFP No: 4574 3.4CommunityBenefit: a. 75 Degrees Cafe has provided a restaurant for families, friends, coworkers, college professors, and business colleagues and partners
to enjoy meals and build relationships for many years. It has also provided jobs, teaching workers the inner workings of the food business and culinary methods. The people in the community
can enjoy a nice meal at a nice location and atmosphere with their families. School teachers, County workers, College professors, construction workers, professional workers, students,
everybody in the community is served by 75 Degrees Cafe. b. 75 Degrees Cafe’s project will provide jobs, teaching culinary skills, supply management, professional cleaning and sanitization
methods, food preparation methods, and business management skills. With these lifetime skills, individuals can obtain new jobs, supporting other businesses. As a result, this will improve
the economy of the community as a whole. c. 75 Degrees Cafe directly benefits the County by providing food through the use of a nice and ambient place for the public to recreate at.
This connects families, friends, and coworkers to build healthy relationships, creating job opportunities by giving people experience and knowledge to enter a variety of different professions.
d. Table Listing Demographics Quantity DirectBenefit IndirectBenefit Upper Class 100% - Mental Health - De-stress -Healthy relationships - Expansion in business - Generating revenue
-less doctors visits -less hospitalization Middle Class 100% - Mental Health - De-stress -job opportunities -Healthy relationships -income generating -Economic increase -Generate revenue
-less doctors visits -less hospitalization Lower Class 100% -self sustainability -mental health -self confidence -Destress -job opportunities -healthy relationships -rise of employment
-taxes generated -decrease welfare -decrease food stamp -less doctor’s visits -less hospitalizations 4 Organization: 75 Degrees Cafe RFP No: 4574 5 Organization: 75 Degrees Cafe RFP
No: 4574 3.5LeveragingPartnershipsandResources: a. 75 Degrees Cafe has leveraged partnerships with individuals who are unemployed,restaurant wholesale suppliers,wholesale food distributor,wholesale
paper goods distributor. Funds were used to pay the unemployed to clean, prepare and package food. Additional funds were used to purchase food, supplies and paper goods from wholesale
companies. b. 75 Degrees Cafe will leverage additional partnerships, funding sources, and other resources by: - Building relationships with business owners, schools, government members,
community leaders, citizens in the community and networking with restaurant owners - Attending different community meetings to expand the resources relating to the food industry and
seeking the challenges and needs of the community to come up with a strategic plan to resolve the issues. -Attending food shows - Hosting a community meeting in to seek resources for
job opportunities -Connecting with unemployment and the workforce division to seek workers - Partnering up with nonprofit organizations to teach life skills - Partnering up with culinary
schools and colleges to train workers Funding can be used to purchase supplies,food, gas, and space for meetings. Additional funds can be used to pay culinary schools and chefs to provide
additional knowledge with recipes and techniques. 6 Organization: 75 Degrees Cafe RFP No: 4574 3.6ManagementCapacityandMeasurableOutcomes: a. 75 Degrees Cafe has extensive experience
running different types of business, while also holding connections and relationships with other vendors. Due to this, 75 Degrees also holds multiple records of calculations and numbers
of losses and profits that allow strategic plans to expand and maximize overall benefits. These connections also allow 75 Degrees to have many resources to rely on, allowing for high
management capacities. b. 75 Degrees Cafe LLC plans to document and record data weekly by acquiring accountants and sales specialists to keep consistent and reliable data. Connecting
with other organizations and parties will allow implementation of support programs. 75 Degrees Cafe will manage and implement funds through hiring workers and partnering up with other
businesses and nonprofit organizations. In order to strategically plan and report the outcomes of the proposal, apps such as Excel and Quickbooks will hold the records and reports of
the results. c. 75 Degrees Cafe has trained multiple workers and students to provide meals in a nice sit-in restaurant serving food for the community. Along with learning how to prepare
food, cook, and cleaning methods, workers and students also have the opportunity to learn communication skills with coworkers and clients. In addition, 75 Degrees Cafe has hosted many
meetings for business network innovators, Hawaii island contractors association and Nature’s Greatest Outcomes, a nonprofit connecting the community together to help balance lives through
the 5 pillars, (spiritually, mentally, physically, emotionally, financially). Studies show that networking and bringing people together to socialize will inspire individuals to share,
open and thrive for opportunities increasing jobs and tax revenues for economic growth and impact. - Job referrals -Opportunity given -Relationship building -Overcoming Trauma -Trained
professionals in all fields -Town hall meetings for ideas to help the community Studies show that by creating a nice atmosphere and ambiance with good food can promote people to come
and connect with other people and professions while helping them to be open and can inspire them to seek more in life. 7 Organization: 75 Degrees Cafe RFP No: 4574 3.7BudgetandFinancials:
a. 75 Degrees Cafe is requesting $75,000.00 b. - Salaries and benefits for employees $30,000.00 - Services and supplies $20,000.00 - Equipment purchases (i.e.,Sandwich prep tables,
freezers, refrigerators) $10,000.00 - Other Expenses (i.e., Rent, renovations,insurance,food etc.) $15,000.00 c. Non-applicable d. Timeline: June2024toAugust2026 - Connect with community
members to relay the importance of the food industry - Host meetings to connect with community members, workforce division to find the job seekers to refer jobs and support programs
- Partner up with nonprofits to provide classes to spread knowledge and interest of the food industry, build positive characters including, reliability, honesty, and perseverance. -Train
employees to cook, clean, pack, and prepare food to gain restaurant experience -Entrepreneur program for workers to thrive in the food industry. -Partnering up with businesses, innovators,
entrepreneurs to have meetings for more referrals for jobs and different opportunities. Funds will be expended through hosting meetings, paying non profits for programs, hiring employees,
purchasing supplies, equipment, and paying for rent and utilities. e. AttachmentD f. TaxReturns 8
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/Attachment A 75 Degrees Cafe LLC (fixed).pdf
Organization: RFP No: 4574 ATTACHMENT A 5.1 PROPOSAL APPLICATION CHECKLIST Applicant: RFP No.: 4574 The applicant’s proposal must contain the following components in the order
shown below. Return this checklist to the purchasing agency as part of the Proposal Application. Item Reference in RFP Format/Instructions Provided Required by Purchasing Agency
Applicant to place “X” for items included in Proposal General: Proposal Application Checklist Section 1, RFP Attachment A X Proposal Application Form Section 1, RFP Attachment
B X Proposal Table of Contents Entity Description & COGS COVID-19 Impacts Project Description Community Benefit Leveraging Partns.
& Res. Mgmt. Capacity & Outcomes Budget & Financials/Statemnt. Section 3, RFP Section 3, RFP X One Unredacted Electronic Copy of Proposal (PDF format) Section 1,
RFP Section 1, RFP X One Redacted Electronic Copy of Proposal (PDF format) Section 1, RFP Section 1, RFP X Certifications: Federal Certifications Section 5, RFP Attachment F,
App. I X Program Specific Requirements: N/A 75 Degrees Cafe LLC x x x x x x
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/Attachment B 75 Degrees Cafe LLC (fixed).pdf
Organization: RFP No: 4574 ATTACHMENT B 5.2 PROPOSAL APPLICATION FORM Project Title: Organization Name: Contact Name: Telephone: Email Address: Project Category: SMALL BUSINESS
ECONOMIC RECOVERY & SUPPORT Funding Summary. Amount SLFRF Funds Requested. $ Funds From Other Sources (if available). $ In-kind Contribution Value (if available). $ Total Project
Cost. $ ACKNOWLEDGEMENT I, the undersigned, hereby certify that the information provided in this County of Hawaiʻi Request for Proposals has been reviewed in its entirety and the
affixed signature accepts responsibility on behalf of said organization to inform its members of the content herein. All terms and conditions of this County of Hawaiʻi Request for Proposals
shall be a part of any contract entered into as a result of this proposal. Signature: Name (please type or print clearly): Title: Date Signed: Small Business Economic Recovery
& Support Program 75 Degrees Cafe LLC Tram Ngo 808-989-3338 naturesgreatestoutcomes@gmail.com 75,000.00 75,000.00 Tram Ngo Owner 5-14-2024
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/certificate 75.pdf Certificate of Vendor Compliance
STATE OF HAWAII STATE PROCUREMENT OFFICE CERTIFICATE OF VENDOR COMPLIANCE This document presents the compliance status of the vendor identified below on the issue date with respect to
certificates required from the Hawaii Department of Taxation (DOTAX), the Internal Revenue Service, the Hawaii Department of Labor and Industrial Relations (DLIR), and the Hawaii Department
of Commerce and Consumer Affairs (DCCA). Vendor Name: 75 DEGREES CAFE LLC DBA/Trade Name: 75 DEGREES CAFE LLC Issue Date: 05/09/2024 Status: Not Compliant Hawaii Tax#: 03970565-12 New
Hawaii Tax#: FEIN/SSN#: XX-XXX8893 UI#: No record DCCA FILE#: 234228 Status of Compliance for this Vendor on issue date: Form Department(s) Status A-6 Hawaii Department of Taxation
Not Compliant 8821 Internal Revenue Service Compliant COGS Hawaii Department of Commerce & Consumer Affairs Compliant LIR27 Hawaii Department of Labor & Industrial Relations Compliant
Status Legend: Status Description Exempt The entity is exempt from this requirement Compliant The entity is compliant with this requirement or the entity is in agreement with agency
and actively working towards compliance Pending A status determination has not yet been made The entity has applied for the certificate but it is awaiting approvalSubmitted The entity
is not in compliance with the requirement and should contact the issuing agency for more informationNot Compliant
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/redacted 2022 tax return new.pdf
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/redacted 2022 tax return RE.pdf
* = =
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/redacted 2023 new.pdf
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/Unredacted 2022 Tax Return RE.pdf
Bid Zip RFP #4574/75 Degrees Cafe LLC_1036955/unredacted 2023 new.pdf
Bid Zip RFP #4574/Arc of Hilo_991413/TabulationByVendor_RFP#4574_orgId_991413.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Arc of Hilo Page of 1 1 General Comments: Please find our proposal attached. Mahalo,
Robert Efford CEO The Arc of Hilo General Attachments: Proposal_RFP_4574_Arc of Hilo Laundry Program_Impact of COVID19_May 9_24.pdf
Bid Zip RFP #4574/Arc of Hilo_991413/Proposal_RFP_4574_Arc of Hilo Laundry Program_Impact of COVID19_May 9_24.pdf
Bid Zip RFP #4574/Cupcakes BOOM_1035951/TabulationByVendor_RFP#4574_orgId_1035951.pdf
County of Hawaii Tabulation Report RFP #4574 - Small Business Economic Recovery & Support Vendor: Cupcakes BOOM Page of 1 1 General Comments: General Attachments: APPENDIX I TO ATTACHMENT
F FEDERAL TERMS AND CONDITIONS (1).pdf ATTACHMENT F- FEDERAL TERMS AND CONDITIONS (1).pdf COH Grant Proposal.pdf COH Grant Proposal REDACTED.pdf
Bid Zip RFP #4574/Cupcakes BOOM_1035951/APPENDIX I TO ATTACHMENT F FEDERAL TERMS AND CONDITIONS (1).pdf
APPENDIX I TO ATTACHMENT F: FEDERAL TERMS AND CONDITIONS Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies, to the best of his or her
knowledge and belief, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence
an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its
instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of
fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure. The Contractor,___________________ , certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition,
the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure,
if any. _______________________________________________ Signature of Contractor’s Authorized Official _________________________________________________ Name and Title of Contractor’s
Authorized Official _______________________________ Date
Bid Zip RFP #4574/Cupcakes BOOM_1035951/ATTACHMENT F- FEDERAL TERMS AND CONDITIONS (1).pdf
FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM ATTACHMENT F: FEDERAL TERMS AND CONDITIONS The Contractor understands that federal funds
are being used for this procurement. The following provisions are hereby made a part of this Contract, and the Contractor understands and agrees to comply with them. 1. EQUAL EMPLOYMENT
OPPORTUNITY (41 C.F.R. Part 60) “During the performance of this Contract, the Contractor agrees as follows: (1) The Contractor will not discriminate against any employee or applicant
for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The Contractor will take affirmative action to ensure that applicants
are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action
shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other
forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment,
notices to be provided setting forth the provisions of this nondiscrimination clause. (2) The Contractor will, in all solicitations or advertisements for employees placed by or on
behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity,
or national origin. (3) The Contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant
has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee
who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees
or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation,
proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the Contractor's legal duty to furnish information. (4) The Contractor
will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the
said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and
applicants for employment. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (5) The Contractor will comply with all provisions of Executive
Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) The Contractor will furnish all information and reports required
by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and
accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of
the Contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated,
or suspended in whole or in part and the Contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures
authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or
by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. (8) The Contractor will include the portion of the sentence immediately preceding paragraph
(1) and the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant
to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The Contractor will take such action with respect
to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that
in the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, the Contractor
may request the United States to enter into such litigation to protect the interests of the United States. The County of Hawaii further agrees that it will be bound by the above
equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, that if the County of Hawaii so participating
is a state or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work
on or under the contract. The County of Hawaii agrees that it will assist and cooperate actively with the administering agency and the Secretary of Labor in obtaining the compliance
of contractors and subcontractors with the equal opportunity clause and the rules, regulations, and relevant orders of the Secretary of Labor, that it will furnish the administering
agency and the Secretary of Labor such information as they may require for the supervision of such compliance, and that it will otherwise assist the administering agency in the discharge
of the agency's primary responsibility for securing compliance. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM The County of Hawaii
further agrees that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from,
or who has not demonstrated eligibility for, Government contracts and federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and
penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the administering agency or the Secretary of Labor pursuant to Part
II, Subpart D of the Executive Order. In addition, the County of Hawaii agrees that if it fails or refuses to comply with these undertakings, the administering agency may take any or
all of the following actions: Cancel, terminate, or suspend in whole or in part this grant (contract, loan, insurance, guarantee); refrain from extending any further assistance to the
County of Hawaii under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from such County of Hawaii;
and refer the case to the Department of Justice for appropriate legal proceedings.” 2. DAVIS-BACON ACT (29 C.F.R. PART 5) NOTE: All Contractors must include the following provisions
in full in any subcontracts. “(1) Minimum wages. (i) All laborers and mechanics employed or working upon the site of the work (or under the United States Housing Act of 1937 or
under the Housing Act of 1949 in the construction or development of the project), will be paid unconditionally and not less often than once a week, and without subsequent deduction
or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of
wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of
Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the Contractor and such laborers and mechanics.
Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis-Bacon Act on behalf of laborers or mechanics are considered wages
paid to such laborers or mechanics, subject to the provisions of paragraph (1)(iv) of this section; also, regular contributions made or costs incurred for more than a weekly period
(but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period.
Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to
skill, except as provided in § 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for
the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination
(including any additional classification and wage rates conformed under paragraph (1)(ii) of this section) and the DavisBacon poster (WH–1321) shall be posted at all times by the Contractor
and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE
AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (ii) (A) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage
determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification
and wage rate and fringe benefits therefore only when the following criteria have been met: (1) The work to be performed by the classification requested is not performed by a classification
in the wage determination; and (2) The classification is utilized in the area by the construction industry; and (3) The proposed wage rate, including any bona fide fringe benefits,
bears a reasonable relationship to the wage rates contained in the wage determination. (B) If the Contractor and the laborers and mechanics to be employed in the classification (if
known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report
of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, U.S. Department of Labor, Washington, DC 20210. The Administrator, or
an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify
the contracting officer within the 30-day period that additional time is necessary. (C) In the event the Contractor, the laborers or mechanics to be employed in the classification
or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate),
the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Administrator for determination.
The Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer
within the 30day period that additional time is necessary. (D) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs (1)(ii) (B) or (C) of
this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. (iii) Whenever
the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the Contractor shall either
pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the Contractor does not make payments
to a trustee or other third person, the Contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide
fringe benefits under a plan or program, Provided, FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM That the Secretary of Labor has found,
upon the written request of the Contractor, that the applicable standards of the Davis-Bacon Act have been met. The Secretary of Labor may require the Contractor to set aside in a separate
account assets for the meeting of obligations under the plan or program. (2) Withholding. The County of Hawaii shall upon its own action or upon written request of an authorized representative
of the Department of Labor withhold or cause to be withheld from the Contractor under this contract or any other Federal contract with the same prime Contractor, or any other federally-assisted
contract subject to Davis-Bacon prevailing wage requirements, which is held by the same prime Contractor, so much of the accrued payments or advances as may be considered necessary
to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the Contractor or any subcontractor the full amount of wages required by the contract. In the
event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work (or under the United States Housing Act of
1937 or under the Housing Act of 1949 in the construction or development of the project), all or part of the wages required by the contract, the (Agency) may, after written notice to
the Contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations
have ceased. (3) Payrolls and basic records. (i) Payrolls and basic records relating thereto shall be maintained by the Contractor during the course of the work and preserved for
a period of three years thereafter for all laborers and mechanics working at the site of the work (or under the United States Housing Act of 1937, or under the Housing Act of 1949,
in the construction or development of the project). Such records shall contain the name, address, and social security number of each such worker, his or her correct classification,
hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B)
of the Davis-Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the
wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B) of the Davis-Bacon
Act, the Contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the
plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits.
Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs,
the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. (ii) FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE
AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (A) The Contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the federal awarding
agency if the agency is a party to the contract, but if the agency is not such a party, the Contractor will submit the payrolls to the County of Hawaii, sponsor, or owner, as the case
may be, for transmission to the federal awarding agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR
5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually
identifying number for each employee (e.g., the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired.
Optional Form WH–347 is available for this purpose from the Wage and Hour Division Web site at http://www.dol.gov/esa/whd/forms/wh347instr.htm or its successor site. The prime Contractor
is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each
covered worker, and shall provide them upon request to the federal awarding agency if the agency is a party to the contract, but if the agency is not such a party, the Contractor will
submit them to the County of Hawaii, sponsor, or owner, as the case may be, for transmission to the federal awarding agency, the Contractor, or the Wage and Hour Division of the Department
of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime Contractor to require a subcontractor
to provide addresses and social security numbers to the prime Contractor for its own records, without weekly submission to the sponsoring government agency (or the County of Hawaii,
sponsor, or owner). (B) Each payroll submitted shall be accompanied by a “Statement of Compliance,” signed by the Contractor or subcontractor or his or her agent who pays or supervises
the payment of the persons employed under the contract and shall certify the following: (1) That the payroll for the payroll period contains the information required to be provided
under § 5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under § 5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information
is correct and complete; (2) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full
weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible
deductions as set forth in Regulations, 29 CFR part 3; (3) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents
for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (C) The weekly submission of a properly executed certification
set forth on the reverse side of Optional Form WH–347 shall satisfy the requirement for submission of the “Statement of Compliance” required by paragraph (3)(ii)(B) of this section.
FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (D) The falsification of any of the above certifications may subject the Contractor
or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. (iii) The Contractor or subcontractor shall
make the records required under paragraph (3)(i) of this section available for inspection, copying, or transcription by authorized representatives of the federal awarding agency or
the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the Contractor or subcontractor fails to submit the required
records or to make them available, the Federal agency may, after written notice to the Contractor, sponsor, County of Hawaii, or owner, take such action as may be necessary to cause
the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds
for debarment action pursuant to 29 CFR 5.12. (4) Apprentices and trainees — (i) Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work
they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training
Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or
her first 90 days of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the
Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The
allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the Contractor as to the entire work force
under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the
applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio
permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a Contractor is performing
construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified
in the Contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's
level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with
the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the
wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall
be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship FEDERAL TERMS AND CONDITIONS
COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM Agency recognized by the Office, withdraws approval of an apprenticeship program, the Contractor will no longer be
permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (ii) Trainees. Except as provided in
29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a
program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen
on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified
in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be
paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe
benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding
journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered
and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification
of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable
wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the Contractor
will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (iii) Equal employment
opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246,
as amended, and 29 CFR part 30. (5) Compliance with Copeland Act requirements. The Contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference
in this contract. (6) Subcontracts. The Contractor or subcontractor shall insert in any subcontracts the clauses contained in 29 CFR 5.5(a)(1) through (10) and such other clauses
as the federal awarding agency may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime
Contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. (7) Contract termination: debarment.
A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a Contractor and a subcontractor as provided in 29 CFR 5.12. FEDERAL
TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (8) Compliance with Davis-Bacon and Related Act requirements. All rulings and interpretations
of the Davis-Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. (9) Disputes concerning labor standards. Disputes
arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with
the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the Contractor (or any of its subcontractors)
and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. (10) Certification of eligibility. (i) By entering into this contract, the Contractor
certifies that neither it (nor he or she) nor any person or firm who has an interest in the Contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue
of section 3(a) of the Davis-Bacon Act or 29 CFR 5.12(a)(1). (ii) No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract
by virtue of section 3(a) of the Davis-Bacon Act or 29 CFR 5.12(a)(1). (iii) The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.” 3. COPELAND
“ANTI-KICKBACK” ACT “Compliance with the Copeland “Anti-Kickback” Act. Contractor. The Contractor shall comply with 18 U.S.C. § 874, 40 U.S.C. § 3145, and the requirements of 29
C.F.R. Part 3 as may be applicable, which are incorporated by reference into this contract. Subcontracts. The Contractor or subcontractor shall insert in any subcontracts the clause
above and such other clauses as FEMA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.
The prime Contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all of these contract clauses. Breach. A breach of the contract
clauses above may be grounds for termination of the contract, and for debarment as a Contractor and subcontractor as provided in 29 C.F.R. § 5.12.” 4. CONTRACT WORK HOURS AND SAFETY
STANDARDS ACT (29 C.F.R. PART 5) “Compliance with the Contract Work Hours and Safety Standards Act. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY
FUNDS PROGRAM (1) Overtime requirements. No Contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics
shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer
or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. (2) Violation;
liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1) of this section the Contractor and any subcontractor responsible
therefor shall be liable for the unpaid wages. In addition, such Contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District
of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic,
including watchmen and guards, employed in violation of the clause set forth in paragraph (1) of this section, in the sum of $27 for each calendar day on which such individual was required
or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1) of this section. (3)
Withholding for unpaid wages and liquidated damages. The County of Hawaii shall upon its own action or upon written request of an authorized representative of the Department of Labor
withhold or cause to be withheld, from any moneys payable on account of work performed by the Contractor or subcontractor under any such contract or any other federal contract with
the same prime Contractor, or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime Contractor, such sums
as may be determined to be necessary to satisfy any liabilities of such Contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph
(2) of this section. (4) Subcontracts. The Contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1) through (4) of this section and also
a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime Contractor shall be responsible for compliance by any subcontractor or lower
tier subcontractor with the clauses set forth in paragraphs (1) through (4) of this section.” [NOTE: In addition to the required language from clauses (1) through (4) above, in any
contract subject only to the Contract Work Hours and Safety Standards Act and not to any other statutes cited in 29 C.F.R. § 5.1, the following provisions also apply.] “Further Compliance
with the Contract Work Hours and Safety Standards Act. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (1) The Contractor or subcontractor
shall maintain payrolls and basic payroll records during the course of the work and shall preserve them for a period of three years from the completion of the contract for all laborers
and mechanics, including guards and watchmen, working on the contract. Such records shall contain the name and address of each such employee, social security number, correct classifications,
hourly rates of wages paid, daily and weekly number of hours worked, deductions made, and actual wages paid. (2) Records to be maintained under this provision shall be made available
by the Contractor or subcontractor for inspection, copying, or transcription by authorized representatives of the Department of Homeland Security, the Federal Emergency Management Agency,
and the Department of Labor, and the Contractor or subcontractor will permit such representatives to interview employees during working hours on the job.” 5. Rights to Inventions Made
Under a Contract or Agreement (37 C.F.R. Part 401) “Rights to Inventions Made Under a Contract or Agreement. Where the federal award meets the definition of “funding agreement” under
37 CFR § 401.2(a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment
or performance of experimental, developmental, or research work under that “funding agreement,” the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, “Rights
to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the
awarding agency.” 6. CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT “Clean Air Act. The Contractor agrees to comply with all applicable standards, orders or regulations
issued pursuant to the Clean Air Act, as amended, 42 U.S.C. § 7401 et seq. The Contractor agrees to report each violation to the County of Hawaii and understands and agrees that
the County of Hawaii will, in turn, report each violation as required to assure notification to the federal awarding agency, and the appropriate Environmental Protection Agency Regional
Office. The Contractor agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with federal assistance provided by the federal awarding
agency. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM Federal Water Pollution Control Act. The Contractor agrees to comply with
all applicable standards, orders, or regulations issued pursuant to the federal Water Pollution Control Act, as amended, 33 U.S.C. § 1251 et seq. The Contractor agrees to report each
violation to the County of Hawaii and understands and agrees that the County of Hawaii will, in turn, report each violation as required to assure notification to the pass-through entity,
if applicable, the federal awarding agency, and the appropriate Environmental Protection Agency Regional Office. The Contractor agrees to include these requirements in each subcontract
exceeding $150,000 financed in whole or in part with federal assistance provided by the federal awarding agency.” 7. DEBARMENT AND SUSPENSION “Suspension and Debarment. This contract
is a covered transaction for purposes of 2 C.F.R. Part 180 and 2 C.F.R. Part 3000. As such, the Contractor is required to verify that none of the Contractor’s principals (defined at
2 C.F.R. § 180.995) or its affiliates (defined at 2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935). The Contractor
must comply with 2 C.F.R. Part 180, subpart C and 2 C.F.R. Part 3000, subpart C, and must include a requirement to comply with these regulations in any lower tier covered transaction
it enters into. This certification is a material representation of fact relied upon by the County of Hawaii. If it is later determined that the Contractor did not comply with 2
C.F.R. Part 180, subpart C and 2 C.F.R. Part 3000, subpart C, in addition to remedies available to the County of Hawaii, the federal government may pursue available remedies, including
but not limited to suspension and/or debarment. The bidder or proposer agrees to comply with the requirements of 2 C.F.R. Part 180, subpart C and 2 C.F.R. Part 3000, subpart C, while
this offer is valid and throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance
in its lower tier covered transactions.” 8. BYRD ANTI-LOBBYING AMENDMENT “Contractors who apply or bid for an award of more than $100,000 shall file the required certification.
Each tier certifies to the tier above that it will not and has not used federally appropriated funds to pay any person or organization for influencing or attempting to influence FEDERAL
TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM an officer or employee of any agency, a Member of Congress, officer or employee of Congress, or
an employee of a Member of Congress in connection with obtaining any federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying
with non-federal funds that takes place in connection with obtaining any federal award. Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward
the certification(s) to the federal awarding agency.” NOTE: Contractor(s) must sign and submit certification regarding lobbying. The Certification is found in Appendix I to these
Federal Terms and Conditions. 9. PROCUREMENT OF RECOVERED MATERIALS “In the performance of this contract, the Contractor shall make maximum use of products containing recovered
materials that are EPA-designated items unless the product cannot be acquired— Competitively within a timeframe providing for compliance with the contract performance schedule; Meeting
contract performance requirements; or At a reasonable price. Information about this requirement, along with the list of EPA-designated items, is available at EPA’s Comprehensive
Procurement Guidelines webpage: https://www.epa.gov/smm/comprehensive- procurement-guideline-cpg-program. The Contractor also agrees to comply with all other applicable requirements
of Section 6002 of the Solid Waste Disposal Act.” 10. PROHIBITION ON CONTRACTING FOR COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES “Prohibition on Contracting for Covered Telecommunications
Equipment or Services. (a) Definitions. As used in this clause, the terms backhaul; covered foreign country; covered telecommunications equipment or services; interconnection arrangements;
roaming; substantial or essential component; and telecommunications equipment or services have the meaning as defined in FEMA Policy 405-143-1, Prohibitions on Expending FEMA Award
Funds for Covered Telecommunications Equipment or Services (Interim), as used in this clause— (b) Prohibitions. (1) Section 889(b) of the John S. McCain National Defense Authorization
Act for Fiscal Year 2019, Pub. L. No. 115-232, and 2 C.F.R. § 200.216 prohibit the head of an executive agency on or after Aug.13, 2020, from obligating or expending grant, cooperative
agreement, loan, or loan guarantee funds on certain telecommunications products or from certain entities for national security reasons. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I
– STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (2) Unless an exception in paragraph (c) of this clause applies, the Contractor and its subcontractors may not use grant, cooperative
agreement, loan, or loan guarantee funds from the Federal Emergency Management Agency to: (i) Procure or obtain any equipment, system, or service that uses covered telecommunications
equipment or services as a substantial or essential component of any system, or as critical technology of any system; (ii) Enter into, extend, or renew a contract to procure or obtain
any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology of any
system; (iii) Enter into, extend, or renew contracts with entities that use covered telecommunications equipment or services as a substantial or essential component of any system,
or as critical technology as part of any system; or (iv) Provide, as part of its performance of this contract, subcontract, or other contractual instrument, any equipment, system,
or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. (c) Exceptions.
(1) This clause does not prohibit Contractors from providing— (i) A service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements;
or (ii) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles.
(2) By necessary implication and regulation, the prohibitions also do not apply to: (i) Covered telecommunications equipment or services that: i. Are not used as a substantial or
essential component of any system; and ii. Are not used as critical technology of any system. (ii) Other telecommunications equipment or services that are not considered covered telecommunications
equipment or services. (d) Reporting requirement. (1) In the event the Contractor identifies covered telecommunications equipment or services used as a substantial or essential
component of any system, or as critical technology as part of any system, during contract performance, or the Contractor is notified of such by a subcontractor at any tier or by any
other source, the Contractor shall report the information in paragraph (d)(2) of this clause to the recipient or subrecipient, unless elsewhere in this contract are established procedures
for reporting the information. (2) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause: FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I
– STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM (i) Within one business day from the date of such identification or notification: The contract number; the order number(s), if applicable;
supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number,
manufacturer part number, or wholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended. (ii) Within 10 business
days of submitting the information in paragraph (d)(2)(i) of this clause: Any further available information about mitigation actions undertaken or recommended. In addition, the Contractor
shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent
future use or submission of covered telecommunications equipment or services. (e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph
(e), in all subcontracts and other contractual instruments.” 11. DOMESTIC PREFERENCES FOR PROCUREMENTS “Domestic Preference for Procurements. As appropriate, and to the extent
consistent with law, the Contractor should, to the greatest extent practicable, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced
in the United States. This includes, but is not limited to iron, aluminum, steel, cement, and other manufactured products. For purposes of this clause: Produced in the United
States means, for iron and steel products, that all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States. Manufactured
products mean items and construction materials composed in whole or in part of non-ferrous metals such as aluminum; plastics and polymer-based products such as polyvinyl chloride pipe;
aggregates such as concrete; glass, including optical fiber; and lumber.” 12. ACCESS TO RECORDS “The Contractor agrees to provide the County of Hawaii, the federal awarding agency,
the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of the Contractor which are directly pertinent
to this contract for the purposes of making audits, examinations, excerpts, and transcriptions. The Contractor agrees to permit any of the foregoing parties to reproduce by any means
whatsoever or to copy excerpts and transcriptions as reasonably needed. FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM The Contractor
agrees to provide the federal awarding agency administrator or his authorized representatives access to construction or other work sites pertaining to the work being completed under
the contract.” 13. FEDERAL SEAL, LOGO, AND FLAGS “The Contractor shall not use the federal awarding agency’s seal(s), logos, crests, or reproductions of flags or likenesses of the
federal awarding agency officials without specific preapproval. The Contractor shall include this provision in any subcontracts.” 14. COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND
EXECUTIVE ORDERS AND ACKNOWLEDGEMENT OF FEDERAL FUNDING “This is an acknowledgement that federal financial assistance will be used to fund all or a portion of the contract. The Contractor
will comply with all applicable federal law, regulations, executive orders, federal policies, procedures, and directives.” 15. NO OBLIGATION BY FEDERAL GOVERNMENT “The federal government
is not a party to this contract and is not subject to any obligations or liabilities to the County of Hawaii, Contractor, or any other party pertaining to any matter resulting from
the contract.” 16. PROGRAM FRAUD AND FALSE OR FRAUDULENT STATEMENTS OR RELATED ACTS “The Contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims
and Statements) applies to the Contractor’s actions pertaining to this contract.” 17. AFFIRMATIVE SOCIOECONOMIC STEPS “If subcontracts are to be let, the prime Contractor is required
to take all necessary steps identified in 2 C.F.R. § 200.321(b)(1)-(5) to ensure that small and minority businesses, women’s business enterprises, and labor surplus area firms are used
when possible.” 18. COPYRIGHT AND DATA RIGHTS “License and Delivery of Works Subject to Copyright and Data Rights. The Contractor grants to the County of Hawaii, a paid-up, royalty-free,
nonexclusive, irrevocable, worldwide license in data first produced in the performance of this contract to reproduce, publish, or otherwise use, including prepare derivative works,
distribute copies to the public, and perform publicly and display publicly such data. For data required by the contract but not first produced in the performance of this contract, the
Contractor will identify such data and grant to the County of Hawaii or acquires on its behalf a license of the same scope as for data first produced in the performance of this contract.
Data, as used herein, shall include any work subject to copyright under 17 U.S.C. § 102, for example, any written reports or literary works, software and/or source code, music, choreography,
pictures or images, graphics, sculptures, FEDERAL TERMS AND CONDITIONS COUNTY OF HAWAI‘I – STATE AND LOCAL FISCAL RECOVERY FUNDS PROGRAM videos, motion pictures or other audiovisual
works, sound and/or video recordings, and architectural works. Upon or before the completion of this contract, the Contractor will deliver to the County of Hawaii data first produced
in the performance of this contract and data required by the contract but not first produced in the performance of this contract in formats acceptable by the County of Hawaii.” 19.
[RESERVED]
Bid Zip RFP #4574/Cupcakes BOOM_1035951/COH Grant Proposal.pdf
Organization: RFP No: 4574 ATTACHMENT A 5.1 PROPOSAL APPLICATION CHECKLIST Applicant: RFP No.: 4574 The applicant’s proposal must contain the following components in the order
shown below. Return this checklist to the purchasing agency as part of the Proposal Application. Item Reference in RFP Format/Instructions Provided Required by Purchasing Agency
Applicant to place “X” for items included in Proposal General: Proposal Application Checklist Section 1, RFP Attachment A X Proposal Application Form Section 1, RFP Attachment
B X Proposal Table of Contents Entity Description & COGS COVID-19 Impacts Project Description Community Benefit Leveraging Partns.
& Res. Mgmt. Capacity & Outcomes Budget & Financials/Statemnt. Section 3, RFP Section 3, RFP X One Unredacted Electronic Copy of Proposal (PDF format) Section 1,
RFP Section 1, RFP X One Redacted Electronic Copy of Proposal (PDF format) Section 1, RFP Section 1, RFP X Certifications: Federal Certifications Section 5, RFP Attachment F,
App. I X Program Specific Requirements: N/A Text X Nikki Savella, Cupcakes, BOOM! X X X X X Organization: RFP No: 4574 ATTACHMENT B 5.2 PROPOSAL APPLICATION
FORM Project Title: Organization Name: Contact Name: Telephone: Email Address: Project Category: SMALL BUSINESS ECONOMIC RECOVERY & SUPPORT Funding Summary. Amount SLFRF Funds
Requested. $ Funds From Other Sources (if available). $ In-kind Contribution Value (if available). $ Total Project Cost. $ ACKNOWLEDGEMENT I, the undersigned, hereby certify that
the information provided in this County of Hawaiʻi Request for Proposals has been reviewed in its entirety and the affixed signature accepts responsibility on behalf of said organization
to inform its members of the content herein. All terms and conditions of this County of Hawaiʻi Request for Proposals shall be a part of any contract entered into as a result of this
proposal. Signature: Name (please type or print clearly): Title: Date Signed: "Payroll Stability Initiative: Sustaining Employment Through Strategic Funding" Cupcakes, BOOM! Nikki
Savella 808-937-9111 cupcakesboom@gmail.com $75,000.00 $75,000.00 Nikki Savella Owner April 30, 2024 Proposal Application Table of Contents 3.1.Entity Description ...................................
...................................................... 5 a. Brief Description .................................................................................
............. 5 b. Principal’s Statement of Qualifications ............................................................................... 6 c. Employment Opportunities
and Community Impact............................................................. 6 d. Community Overview...........................................................
.................................................... 6 e. Certificate of Good Standing ..................................................................................
............ 7 3.2 COVID-19 Impacts...................................................................................... 8 a. Description of Economic Harm ...........................................
.......................................... 8 — Direct Impacts ................................................................................................ 8
— Indirect Impacts ................................................................................................ 8
— Mandated Closure ................................................................................................ 8 3.3. Project Description........................................................
.................. 9 a. Description of Project ...................................................................................................... 9 b.
Proposal Response to COVID-19 Economic Impacts and ARPA Guidelines................ 9 c. Economic Harms and Costs Incurred ...................................................
................................................... 9 3.4. Community Benefit ......................................................................................................
10 a. Entity's History of Community Benefits .............................................................................................. 10 b. Project's
Ongoing Community Benefits ............................................................................... 10 c. Project's Impact on the County................................
......................................................... 10 d. Direct and Indirect Beneficiaries Table .........................................................
.................................... 10 3.5. Leveraging Partnerships and Resources...........................................................................
11 a. Track Record of Leveraging Partnerships and Funding.............................................................11 b. Leveraging Additional Resources for
Proposal ............................................................................... 11 3.6. Management Capacity and Measurable Outcomes....................................
......................... 12 a. Entity's Management and Reporting Capacity ............................................................................... 12 b.
Proposal Implementation and Reporting Plan................................................................................... 12 c. Economic Impact and Documentation
Strategy................................................................................12 3.7. Budget and Financials................................................
........................................................... 13 a. Funding Request Summary .....................................................................................
......... 13 b. Budget Narrative and Matching Funds ............................................................................... 13 c. Previous Funding Received............
................................................................................ 13 d. Project Timeline and Completion Deadlines......................................
............................................13 e. Attachment D: Line Item Budget and Funding Request……………………………………………….14 f. Financial
Document Attachments........................................................................................ — 2021 State and Federal Tax Returns ......................
.......................................................................... — 2022 State and Federal Tax Returns .....................................................................
........................... — 2022 Profit and Loss Statements ................................................................................................
— 2022 Balance Sheet ................................................................................................ — 2023 Profit
and Loss Statements ................................................................................................ — 2023 Balance Sheet .........................................
....................................................... 5.0 Attachments .........................................................
.................................................. a. One Unredacted Electronic Copy of Proposal .................................................................
............... a. One Redacted Electronic Copy of Proposal ................................................................................ a. Federal Certifications
................................................................................ ENTITY DESCRIPTION Cupcakes, BOOM!: A Sweet Journey of Community, Creativity, and Resilience
Aloha, my name is Nikki. Born and raised Hilo girl, native Hawaiian māmā of 3, and visionary creator of Cupcakes, BOOM! A tale of sweet success rooted in the heart of our community.
Nestled in the rainy town of Hilo, Hawaii, Cupcakes, BOOM! stands as a testament to the power of passion, perseverance, and a sprinkle of island magic. For Nikki, the journey began not
with grand aspirations but with a simple desire to be a fully present Mom and serve her beloved hometown.
As a small-town local girl, Nikki's dreams took shape within the walls of a modest twobedroom house back in 2013. It was here that she began to hone in on her confectionery skills and
talents, one cupcake at a time. Little did she know, those humble beginnings would soon BOOM! into something spectacular, igniting a sweet revolution that would captivate the hearts
and taste buds of her community.
The journey to success was not without its challenges. Nikki navigated through ups and downs, facing hills and valleys, and weathering storms along the way. Yet, amidst the chaos, she
remained steadfast in her resolve, fueled by an unwavering commitment to her core values: "God, Family & Community."
With each cupcake baked and every macaron meticulously crafted, Cupcakes, BOOM! became more than just a bakery; it became a beacon of hope, a symbol of resilience, and a gathering place
for the community to come together and celebrate life's sweet moments.
In 2014, at the age of 29, Nikki took a leap of faith and signed her first commercial lease. It was a momentous occasion, marking the beginning of a new chapter in her entrepreneurial
journey. From that day forward, there was no looking back.
Today, nearly a decade later, Cupcakes, BOOM! stands as a bustling bakery, bustling with activity and brimming with joy. Nikki's unwavering dedication, coupled with the support of her
community, has transformed her once-small hole-in-the-wall bakery into a thriving hub of creativity and connection.
But beyond the delectable treats and Instagram-worthy cake designs lies a deeper truth—a truth rooted in faith, family, and the unbreakable bonds of community. For Nikki, success is
not measured in dollars and cents but in the smiles of her customers, the laughter of her team members, and the sense of belonging that permeates every corner of her bakery.
As the journey continues, Nikki remains guided by the words of Psalm 46:5: "God is within her, she will not fail." With faith as her compass and community as her anchor, there's no limit
to what Cupcakes, BOOM! can achieve.
The overarching goals of Cupcakes, BOOM! are steadfast: to continue serving God, Family, and Community through desserts inspired by Hawai'i and handcrafted in Hawai'i by local families.
Each creation not only reflects the rich, vibrant flavors of the islands but also embodies the spirit of aloha that Nikki and her team pour into every batch. As Cupcakes, BOOM! continues
to grow and evolve, these pillars remain at the heart of everything we do, ensuring that our bakery not only produces sweet treats but also fosters a sense of unity and belonging among
all who walk through our doors.
At Cupcakes, BOOM!, Nikki leads our team with passion and expertise. A born and raised Hilo girl and a 2003 graduate of Waiākea High School, Nikki embodies our commitment to our community.
With over a decade of experience in baking, she has grown our bakery from humble beginnings to a local favorite.
Nikki's leadership is backed by our skilled team of pastry chefs, bakers, and customer service professionals. Together, we navigate challenges and deliver exceptional products to our
customers. Our qualifications include degrees in culinary arts and hands-on baking experience. We thrive in a competitive industry, earning the trust of our customers.
Outside of the bakery, Nikki actively engages with local schools and leads a group of fearless wāhine leaders across Hawai'i. Committed to empowering women-owned small businesses, she
embodies our values of quality, integrity, and community. With our expertise and passion, we're dedicated to leading Cupcakes, BOOM! to continued success and making a positive impact
in our communities.
Cupcakes, BOOM! currently provides opportunities for employment to seven individuals, including pastry chefs, bakers, and customer service professionals. With plans to expand our team,
we aim to add three more employees in the near future, further contributing to job creation and economic growth in our community.
The community of Big Island served by Cupcakes, BOOM! encompasses a diverse population of residents, visitors, and businesses. Located in Hilo, Hawaii, our bakery is deeply rooted in
the local community, serving as a gathering place for families, friends, and celebrations. We take pride in offering delicious desserts that showcase the unique flavors and culture of
the Hawaiian islands, connecting with customers from all walks of life. Our commitment to community engagement extends beyond our storefront, as we actively participate in local events,
support schools, and collaborate with other businesses to promote economic development and community well-being. Through our products, services, and community involvement, we strive
to make a positive impact on the lives of those we serve on the Big Island. Department of Commerce and Consumer Affairs CERTIFICATE OF GOOD STANDING I, the undersigned Director of
Commerce and Consumer Affairs of the State of Hawaii, do hereby certify that according to the records of this Department, CUPCAKES, BOOM! LLC was organized under the laws of the State
of Hawaii on 03/20/2013 ; that it is an existing limited liability company in good standing and is duly authorized to transact business. IN WITNESS WHEREOF, I have
hereunto set my hand and affixed the seal of the Department of Commerce and Consumer Affairs, at Honolulu, Hawaii.
Dated: April 30, 2024 Director of Commerce and Consumer Affairs To check the authenticity of this certificate, please visit: http://hbe.ehawaii.gov/documents/authent
icate.html Authentication Code: 498869-COGS_PDF-104223C5 COVID-19 IMPACTS During the global pandemic, Cupcakes, BOOM! faced significant economic challenges that impacted all aspects of
its operations, highlighting the vulnerability of small businesses during unprecedented crises. Owner Nikki confronted immediate financial uncertainty as the potential sudden loss of
revenue streams loomed. With lockdowns and social distancing measures in place, the bakery's main income source—customer foot traffic—halted, potentially causing a substantial drop in
daily sales.
The pandemic also triggered a surge in operational costs. Supply chain disruptions led to escalating prices for essential ingredients and baking supplies. For instance, the cost of a
case of eggs skyrocketed from $23.99 to $38.99 practically overnight, and it has since climbed to $44.99. Additionally, the need for enhanced sanitation measures required investments
in extra cleaning supplies and protective equipment for staff, further straining the budget. These heightened costs coincided with a period of record-low revenue, creating a severe financial
squeeze.
One of the most significant challenges was covering payroll and other operating expenses. Nikki was committed to her staff, viewing them not just as employees but as family and vital members
of the community. The thought of laying off staff was distressing, but with the bakery’s income potentially severely diminishing, meeting payroll became a daunting task. Nikki found herself
having to make difficult choices, including reducing hours, while also taking on a significant portion of the production needs herself to continue supporting her team and serving her community.
Indirectly, the pandemic took a toll on Cupcakes, BOOM! in profound ways. The emotional and mental strain on Nikki and her team was significant. Uncertainty, health concerns, and adapting
to rapidly changing regulations affected morale and well-being. Moreover, the bakery's role as a community gathering place was disrupted. Cancelled or downscaled celebrations and events
led to a significant loss of business beyond everyday sales.
Furthermore, the broader economic downturn reduced customers' disposable income, impacting spending on non-essential goods like specialty desserts. Even as the immediate crisis phase
of the pandemic eased, lasting economic effects continued to affect consumer behavior.
Cupcakes, BOOM! was fortunate to avoid mandatory closure during challenging times.
In response, Cupcakes, BOOM! adapted by enhancing its online presence, offering contactless delivery and pickup, and engaging creatively with customers through social media. These strategies
were crucial for survival and the gradual recovery of the business. However, the pandemic necessitated taking out capital loans and maxing out two credit cards to meet increased costs,
serving as a reminder of the importance of resilience and adaptability in facing future crises. PROJECT DESCRIPTION Cupcakes, BOOM! is seeking a grant of $75,000 to cover essential
payroll expenses, facilitating our ongoing recovery from the adverse impacts of the global pandemic. As a small business deeply rooted in our community, we have faced significant economic
challenges due to the pandemic's disruptions. This grant will enable us to sustain operations, retain our dedicated team members, and continue serving our community with the same passion
and commitment that defines our brand.
Increasing Resiliency:
The grant funding will bolster Cupcakes, BOOM!'s resilience by providing crucial support during a time of financial uncertainty. By covering essential payroll expenses, we can mitigate
the risk of layoffs and maintain a stable workforce, ensuring continuity in our operations and preserving the skills and expertise of our team members. This resilience is essential for
navigating future challenges and uncertainties, allowing us to adapt and thrive in the face of adversity.
Supporting Recovery:
The grant will play a vital role in supporting Cupcakes, BOOM!'s recovery efforts as we strive to rebuild and revitalize our business in the wake of the pandemic. By alleviating financial
strain and providing relief for our payroll expenses, we can redirect resources towards strategic initiatives aimed at driving growth and sustainability. This support will enable us
to reinvest in our business, explore new opportunities for expansion, and position ourselves for long-term success in a post-pandemic landscape.
Providing Relief:
For Cupcakes, BOOM!, the grant represents much-needed relief from the financial pressures that have weighed heavily on our business throughout the pandemic. By covering essential payroll
expenses, the grant will alleviate immediate financial burdens, allowing us to focus on serving our customers and supporting our community. This relief is instrumental in restoring stability
and confidence, providing a lifeline for our business as we navigate the challenges ahead.
Conclusion:
Cupcakes, BOOM! is deeply grateful for the opportunity to apply for this grant and for the support of our community and ‘ohana. With your assistance, we can increase our resilience,
support our recovery efforts, and provide much-needed relief for our business. Together, we can overcome the challenges posed by the global pandemic and emerge stronger and more resilient
than ever before. Thank you for considering our proposal and for your commitment to supporting small businesses like ours.
Based on the U.S. Treasury's guidelines for eligible uses of ARPA funds, the exact line regarding the use of funds for payroll expenses to provide financial relief is as follows:
"Allowable uses of funds include ... responding to workers performing essential work during the COVID-19 public health emergency by providing premium pay to eligible workers ... and
providing grants to small businesses to provide paid sick and family leave or to cover payroll or operating costs, including the continuation of health care benefits" (U.S. Department
of the Treasury, "Coronavirus State and Local Fiscal Recovery Funds: Use of Funds")." COMMUNITY BENEFIT Cupcakes, BOOM! has a rich history of creating community benefits that extend
beyond its delectable desserts. Since its inception, Cupcakes, BOOM! has served as a pillar of the community, providing not only delicious treats but also opportunities for employment,
economic growth, and community engagement.
Cupcakes, BOOM! has a history of creating community benefits beyond its desserts. It serves as a hub for employment, economic growth, and community engagement.
People Served: Through quality service, Cupcakes, BOOM! delights countless customers, enhancing life's special moments.
Jobs Created: The bakery employs bakers, decorators, and staff, providing financial stability and career opportunities.
Tax Revenue Generated: Cupcakes, BOOM! contributes to the local economy through tax revenue, supporting vital services.
Ongoing Community Benefits: The project sustains operations, preserving jobs and economic stability. It maintains the bakery's reputation for quality and community engagement.
Benefits to the County: Supporting local businesses like Cupcakes, BOOM! boosts economic activity, job creation, and tax revenue. The bakery's presence enhances community vibrancy and
identity, making the county more desirable.
The table outlines Cupcakes, BOOM!'s diverse beneficiaries, including customers, employees, local suppliers, and the County of Hawaii. It showcases the direct benefits to customers and
employees, such as enjoyment of treats and employment opportunities, as well as broader benefits to the community, such as economic growth and community vibrancy.
Beneficiary Type Quantity General Demographics Other Benefits Direct Customers Thousands Diverse demographic (all ages) Access to delicious desserts, memorable experiences, support for
special occasions Employees 7 Local residents Employment opportunities, skill development, financial stability, career advancement Local Suppliers 10+ Local businesses Economic support
for local suppliers, fostering community partnerships Community Members Hundreds Residents of all ages and backgrounds Enhanced quality of life, sense of community, opportunities for
engagement and celebration County of Hawaii N/A Residents and local businesses Economic growth, job creation, tax revenue generation, community vibrancy LEVERAGING PARTNERSHIPS AND
RESOURCES Cupcakes, BOOM! boasts a commendable track record of adeptly leveraging partnerships, funding, and various resources to bolster its operations and community engagement initiatives.
Through strategic collaborations with local suppliers, businesses, and community organizations, the bakery has successfully enhanced its offerings and expanded its reach.
One notable example of Cupcakes, BOOM!'s effective partnership utilization is its collaboration with local suppliers to source high-quality ingredients. By forging strong relationships
with these suppliers, the bakery not only ensures the freshness and quality of its products but also supports the local economy by patronizing nearby businesses.
Additionally, Cupcakes, BOOM! has demonstrated a commitment to community involvement by partnering with organizations to host events, fundraisers, and special promotions. These collaborations
serve to deepen the bakery's roots within the community, fostering stronger connections and enhancing brand visibility.
Overall, Cupcakes, BOOM!'s proven ability to leverage partnerships, funding, and resources underscores its dedication to operational excellence and community enrichment.
As part of this proposal, Cupcakes, BOOM! is poised to further leverage partnerships, funding, and other resources to maximize the impact of the grant funds. Building upon its existing
relationships with local suppliers, the bakery aims to explore opportunities for cost-saving measures and mutually beneficial collaborations. By strengthening these partnerships, Cupcakes,
BOOM! can enhance its operational efficiency and sustainability.
Furthermore, Cupcakes, BOOM! is committed to actively seeking out additional funding opportunities, such as grants and sponsorships, to supplement the grant funds allocated for this
proposal. By diversifying its funding sources, the bakery can expand its capacity to serve the community and undertake impactful initiatives.
Through strategic utilization of partnerships, funding, and other resources, Cupcakes, BOOM! endeavors to amplify the impact of the grant, ensuring the continued success of its operations
and its ongoing contribution to community well-being. MANAGEMENT CAPACITY AND MEASURABLE OUTCOMES Cupcakes, BOOM! has a solid track record in effectively managing, implementing, measuring,
and reporting on grant funds, with a specific focus on payroll expenses as the main use of the grant funds. The bakery's experience in financial management and community engagement positions
it well to handle the responsibilities associated with grant management.
Cupcakes, BOOM! has previously managed various initiatives, including partnerships and events, demonstrating its ability to allocate resources efficiently. With a clear focus on retaining
jobs and sustaining operations, the bakery will utilize established processes to track payroll expenses and ensure transparency and accountability in fund utilization.
As part of the proposal, Cupcakes, BOOM! will establish clear objectives and performance indicators related to payroll expenses. This includes setting targets for retaining jobs, maintaining
employee satisfaction, and monitoring budget allocations. Regular monitoring and reporting will allow the bakery to assess progress and make adjustments as needed to ensure the effective
use of grant funds.
Cupcakes, BOOM! will measure the impact of the grant funds by tracking metrics such as the number of jobs retained, employee satisfaction levels, and overall payroll expenditure. These
metrics will provide tangible evidence of the grant's impact on supporting the bakery's workforce and sustaining operations.
In terms of documentation, Cupcakes, BOOM! will maintain detailed records of payroll expenses, financial transactions, and employee feedback. These records will serve as a comprehensive
source of information for measuring the impact of the grant and demonstrating accountability to stakeholders.
Overall, Cupcakes, BOOM! is well-positioned to leverage grant funds effectively to support its workforce and sustain operations. By focusing on payroll expenses as the main use of funds
and implementing robust monitoring and reporting processes, the bakery will continue to demonstrate its commitment to supporting its employees and driving positive economic outcomes
in the community. BUDGET AND FINANCIALS Cupcakes, BOOM! respectfully requests a grant of $75,000 to sustain and stabilize our operations through direct payroll support, as part of our
ongoing recovery from the significant economic impacts caused by the global pandemic.
The requested grant of $75,000 will be primarily allocated towards covering essential payroll expenses at Cupcakes, BOOM!. This funding will directly support our dedicated team members,
ensuring their continued employment and providing financial stability during these challenging times. The payroll expenses include wages, salaries, and benefits for our staff, who play
a vital role in maintaining operations and serving our community. By prioritizing payroll support, we aim to retain our skilled workforce and sustain our commitment to delivering highquality
products and services. The allocation of funds towards payroll expenses reflects our dedication to supporting our employees and ensuring the long-term success and resilience of our business.
Cupcakes, BOOM! has received previous funds to support our operations during challenging times. Specifically, on May 7, 2020, we received Paycheck Protection Program (PPP) funding totaling
$10,800. These funds were allocated towards covering payroll expenses from May 8, 2020, to June 30, 2020, providing critical support for our workforce during that period.
Additionally, on March 4, 2023, we received Employee Retention Credit (ERC) funding amounting to $78,000. These funds were allocated towards covering payroll taxes incurred from March
12, 2020, to December 31, 2021. The ERC funding played a vital role in helping us manage our financial obligations and sustain our operations during this challenging period.
We are grateful for the support provided through these funding initiatives, which have enabled us to maintain our workforce, cover essential expenses, and continue serving our community.
**Project Timeline for Payroll Expenses Utilization**
- **Total Grant Amount:** $75,000
- **Weekly Payroll Expenses:** $5,000
**Week-by-Week Breakdown**
- **Weeks 1-15:** Allocate $5,000 per week for payroll expenses.
**Key Dates**
- **Grant Start Date:** Estimated - July 1, 2024
- **Completion Date for Fund Utilization:** October
**Reporting and Monitoring**
- **Monthly Reporting:** Monitor payroll expenses and report usage.
- **Final Report Due:** 10/21/2024
This streamlined timeline allocates $5,000 weekly for payroll expenses over a 15-week period, ensuring efficient fund utilization and compliance with grant conditions.
5.3 Attachment D: Line Item Budget County of Hawaiʻi Small Business Economic Recovery & Support Program Applicant Name: Nikki Savella, Cupcakes, BOOM! Project Name: "Payroll Stability
Initiative: Sustaining Employment Through Strategic Funding" Revenue Community Resiliency Grants Program Request Amount $ 75,000 Organization Funds $ Other Partner Funds* $ State
Funds* $ Other Federal Funds* $ TOTAL REVENUE $ 75,000 Expense Salaries & Benefits $ 75,000 Services & Supplies $ Contracts for Service Delivery* $ Equipment Purchases* $ Other Expenses*
$ TOTAL EXPENSE $ 75,000 NET $ - * Please describe any of the following: Other Partners: State Funding: Federal Funding: Contracts for Service Delivery Equipment Purchases Other
Expenses 1 2021 Federal Tax Return Filing Instructions FOR THE YEAR ENDING December 31, 2021 Prepared for NICOLE K SAVELLA Tax Summary Gross IncomeŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $17005 Adjusted
Gross IncomeŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $15804 Total DeductionsŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $13201 Total Taxable IncomeŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $2603 Total TaxŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $2663 Total PaymentsŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ
ŜŜ $5800 Refund AmountŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $3137 Amount You OweŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $0 Make check payable to Mailing Address Since you are filing your return electronically and you
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ENDING December 31, 2021 Prepared for NICOLE K SAVELLA Tax Summary Adjusted Gross IncomeŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ$ 15,804 Total DeductionsŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $ 0 Total Taxable IncomeŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ
$ 11,316 Total TaxŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $ 484 Total PaymentsŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $ 0 Refund AmountŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $ 0 Amount You OweŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜŜ $ 484 Make check
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