10-Combined Corporate Accountability and Workforce Safety Affidavit 3-21-2024 FINAL.docx
DOCX document 31 KB Posted
- Attached to
- CDBG-DR-Basement Sanitization/HVAC State and local contract opportunity
- Solicitation number
- 541543
- Issued by
- Wayne County, Detroit City, Michigan
About this file
This is a Combined Affidavit of Workforce Safety and Corporate Accountability required by the City of Detroit Office of Contracting and Procurement (OCP) for contract awards related to the CDBG-DR Basement Sanitization/HVAC project in Michigan. The affidavit must be completed and notarized by an authorized representative, typically the Chief Executive Officer or designee, of any contractor seeking to perform basement cleaning/sanitizing and HVAC system repair or replacement services under Phase 2 of the CDBG-DR Private Sewer Repair Program (PSRP). The document requires attestation to workforce safety compliance, including confirmation that all employees and subcontractors handling hazardous materials have completed appropriate hazardous materials awareness training and that all craft labor personnel have completed the OSHA 10-hour construction training course established by the U.S. Department of Labor.
The affidavit also requires corporate accountability attestations, whereby contractors must verify they possess all required licenses, registrations, and certificates to perform the work; have not had any required credentials revoked within the past five years; and have not been debarred by any federal, state, or local governmental agency within the past three years. Misrepresentations or false statements in the affidavit are treated as fraudulent activity under City Ordinance 17-5-12 (g)(1) and MCL 750.249, with potential intent to defraud the City of Detroit. The completed affidavit must include the printed name and title of the authorized representative, signature, date, and notarization by a qualified notary public before submission to OCP for clearance.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 9-RFQ 541543.pdf | ||
| 5-EMPLOYEE RIGHTS ON GOVERNMENT CONTRACTS.pdf | ||
| 3-Attachment D-2 - Conditions of Award.pdf | ||
| 1-Attachment D-1 Required Forms Affidavits.pdf | ||
| 4-Attachment A - Respondent Questionnaire.docx | DOCX document | |
| 7-Attachment C - Pricing.docx | DOCX document | |
| 6-SAM.gov-prevailing wage.pdf | ||
| 2-Attachment E - Professional Service Contract Sample.docx | DOCX document | |
| 8-Equalization Credit Statement.pdf |
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Text version
COMBINED AFFIDAVIT
OF
WORKFORCE SAFETY &
CORPORATE ACCOUNTABILITY
Contract No:_____________ I am , and state under oath:
I am the [INSERT OFFICER TITLE HERE] of [INSERT NAME OF ORGANIZATION] (“Contractor”), and represent that I am authorized to execute this affidavit on behalf of the Contractor, and its owners, directors, and officers. I am the Chief Executive Officer, or authorized designee, and attest to the Contractor’s compliance with the following requirements:
A. I represent that the following statements regarding Workforce Safety are true:
| (1) | All employees and subcontractors handling or interacting with hazardous materials have been properly trained, through completion in hazardous materials awareness training; or participation and completion in the requisite awareness training program compliant with state and federal guidelines; and |
| (2) | All employees and subcontractors providing craft labor have at a minimum completed the OSHA 10-hour construction training course for safety established by the U.S. Department of Labor, Occupational Safety and Health Administration. |
B. I also represent that the following statements regarding Corporate Accountability are true:
| (1) | The Contractor and its employees have the required licenses, registrations, and certificates required to perform the work as stated in the solicitation; and |
| (2) | The Contractor has not had any licenses, registrations, or certificates which are required for the performance of the contract revoked in the past five (5) years; and |
| (3) | The Contractor has not been debarred by any federal, state or local governmental agency or authority in the past three (3) years. |
I understand and acknowledge that the above representations are material and important and will be relied upon by the City of Detroit in determining the Contractor’s eligibility for this contract(s)/purchase order(s). I understand and acknowledge, and the Contractor understands and acknowledges that the City of Detroit will treat any misstatement or false representation in this affidavit as a fraudulent activity relating to the eligibility of award for this contract(s)/purchase order(s) under City Ordinance 17-5-12 (g)(1), with intent to defraud the City of Detroit pursuant to MCL 750.249.
**This Document MUST be Notarized** Complete the section below
Printed Name & Title of Authorized Representative:
Signature of Authorized Representative:
Date:
This document was acknowledged, subscribed, and sworn before me <INSERT DATE HERE> day of <INSERT MONTH HERE>, 20XX, by <INSERT NAME OF AUTHORIZED AGENT HERE>, the <INSERT OFFICER TITLE HERE> of <INSERT NAME OF ORGANIZATION HERE>.
Signature of Notary:
Printed Name of Seal of Notary:
My Commission Expires: / /
THIS SECTION IS FOR OCP USE ONLY:
Affidavits Received & Clearance Date: ______________
Version 3/21/2024
File details come from the government source that posted it. Updated .