3-Affidavit.pdf
PDF 102 KB Posted
- Attached to
- Park Site Furnishings
- Solicitation number
- 26-008
- Issued by
- Jackson County, Missouri
About this file
This is an affidavit template document for Jackson County, Missouri, designed to accompany bid submissions for county contracts. The affidavit requires the authorized representative of a bidding firm to certify under oath various conditions and representations regarding the bidder's eligibility and compliance with county procurement requirements. The document does not specify particular products, services, quantities, response deadlines, or contract terms, as it functions as a standardized certification form rather than a solicitation document.
The affidavit requires bidders to affirm that no county officers, agents, or employees have financial interests in the bid; that county employees would not benefit from any resulting contract; that the bidder is current on Jackson County tax obligations or had no taxable property in the county as of December 31, 2025; that the bidder has not engaged in collusion or restraint of trade; that the bidder is not listed on the General Services Administration's debarred and suspended parties list; and that the bidder complies with federal work authorization programs and does not knowingly employ unauthorized aliens. The affidavit must be notarized and submitted as part of the bid response, though the template does not prescribe specific pricing terms, set-asides, funding sources, or other financial conditions. Bidders completing this form certify their understanding of and compliance with these statutory and regulatory requirements as a condition of contract eligibility.
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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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