3-Affidavit.pdf
PDF 101 KB Posted
- Attached to
- Resale Fishing Equipment, Products, & Supplies
- Solicitation number
- 25-042
- Issued by
- Jackson County, Missouri
About this file
This document is an Affidavit for a bidding process involving Jackson County, Missouri. The affidavit requires a bidder to make several certifications and declarations, including: (1) No county officer, agent, or employee has a financial interest in the bid, (2) the bidder is either listed on county tax rolls or has no taxable property as of December 31, 2023, (3) the bidder has not engaged in collusion or trade restraint, (4) the bidder is not on the GSA's list of debarred or suspended parties, and (5) the bidder certifies enrollment in a federal work authorization program and does not knowingly employ unauthorized aliens.
The affidavit serves as a formal sworn statement that the bidder meets specific ethical and legal requirements for participating in a county procurement process. Key compliance elements include tax status verification, workforce authorization, anti-collusion assurances, and authorization for potential tax record audits. The document must be signed by the bidder, notarized, and includes spaces for the bidder's name, title, signature, and notary public certification, with provisions for documenting the date of execution and the notary's commission expiration.
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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, 2023, 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 .