3-Affidavit.pdf
PDF 101 KB Posted
- Attached to
- Deep Core Aerifier
- Solicitation number
- 25-055
- Issued by
- Jackson County, Missouri
About this file
This is an Affidavit form used by Jackson County, Missouri for bidders participating in procurement solicitations. The affidavit requires the authorized representative of a bidding entity to certify under oath various conditions and representations regarding the bid submission. Key certifications include confirmation that no Jackson County officers, agents, or employees have financial interests in the bidder's proposal; that no County employees would benefit from any awarded contract; and that the bidder either maintains current tax roll status without delinquency or had no taxable property in the County as of December 31, 2025. The affidavit further requires bidders to confirm they have not engaged in collusion or restraint of trade activities, are not listed on the General Services Administration's debarred or suspended parties report, and are enrolled in a federal work authorization program. Additionally, bidders must affirm they do not knowingly employ unauthorized aliens in connection with contracted services.
The affidavit is a mandatory submission document that must be completed, signed by an authorized representative of the bidding organization, and notarized before a notary public. This form serves as a compliance and eligibility verification tool within Jackson County's procurement process, ensuring bidder integrity and adherence to federal and local regulatory requirements. No specific pricing information, contract terms, or project-specific details are contained within this affidavit template, as it functions as a standardized certification document applicable across multiple County solicitations.
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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: ______________________________________________
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