3-Affidavit.pdf
PDF 101 KB Posted
- Attached to
- T-Shirts & Wearing Apparel
- Solicitation number
- 25-050
- Issued by
- Jackson County, Missouri
About this file
This affidavit template is utilized by Jackson County, Missouri for bidders responding to solicitations, requiring authorized representatives to certify compliance with county regulations and federal requirements. The document mandates that affiant representatives attest to the absence of conflicts of interest involving county officers, agents, or employees; confirm the bidder's tax compliance status or tax-exempt property status as of December 31, 2025; and certify non-participation in collusion or restraint of trade activities. Additionally, bidders must confirm they are not listed on the General Services Administration's debarred and suspended parties list and certify enrollment in a federal work authorization program with verification that no unauthorized aliens are employed in connection with contracted services.
The affidavit requires notarization and serves as a prerequisite for bid consideration, establishing the affiant's authority to represent the bidding entity and warranting the truthfulness of certifications under oath. This standardized form applies across Jackson County solicitations and does not contain project-specific details, pricing information, or contract terms but rather functions as a compliance and integrity verification mechanism for all county procurement activities.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
AFFIDAVIT
STATE OF ______________________ )
) SS.
COUNTY OF ____________________ )
_________________________________of the city of ________________________________ County of ____________________ State of __________________being duly sworn on her or his oath, deposes and says;
1. That I am the _________________________ (Title of Affiant) of __________________________________(Name of Bidder) and have been authorized by said Bidder to make this Affidavit upon my best information and belief, after reasonable inquiry as to the representations herein.
2. No Officer, Agent or Employee of Jackson County, Missouri is financially interested directly or indirectly what Bidder is offering to sell to the County pursuant to this Invitation (though no representation is made regarding potential ownership of publicly traded stock of bidder).
3. If Bidder were awarded any contract, job, work or service for Jackson County, Missouri, no Officer, Agent or Employee of the
County would be interested in or receive any benefit from the profit or emolument of such.
4. Either Bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri and is not delinquent in the payment of any taxes due to the County or Bidder did not have on December 31, 2025, any property subject to taxation by the County and if bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri, bidder agrees to permit an audit of its records, if requested by the Jackson County Director of Assessment, as they relate to the assessment of Business Personal Property.
5. Bidder has not participated in collusion or committed any act in restraint of trade, directly or indirectly, which bears upon anyone's response or lack of response to the Invitation.
6. Bidder certifies and warrants that Bidder or Bidder's firm/organization is not listed on the General Services Administration's Report of Debarred and/or Suspended Parties.
7. Bidder certifies and affirms its enrollment and participation in a federal work authorization program with respect to the employees working in connection with the contracted services.
8. Bidder certifies and affirms that it does not knowingly employ any person who is an unauthorized alien in connection with the contracted services.
_______________________________ (Name of Bidder)
By: ____________________________ (Signature of Affiant)
_______________________________ (Title of Affiant)
Subscribed and sworn to before me this ______ day of _________________, 20____
NOTARY PUBLIC in and for the County of _______________________________(SEAL)
State of _____________________________
My Commission Expires: ______________________________________________
File details come from the government source that posted it. Updated .