3-Attachment 4 - Sworn Statement of Respondent.pdf
PDF 68 KB Posted
- Solicitation number
- RFP-2026-004
- Issued by
- Milwaukee County, Mattoon Village, Wisconsin
About this file
This is a Sworn Statement of Respondent form issued by Milwaukee County, Wisconsin as part of a Request for Proposal (RFP) for Basic Life Insurance and Optional Life Insurance Program services. The RFP seeks qualified and experienced firms to provide insurance coverage and full administrative services for the County's life insurance programs. The County intends to award a contract for an initial three-year term with renewal options available. Willis Towers Watson Midwest, Inc. serves as Milwaukee County's Broker of Record for this procurement.
The sworn statement form requires the respondent's authorized representative to certify under oath that they have thoroughly reviewed all RFP documents, attachments, questions and answers, addenda, and related information provided by Milwaukee County before submission. The respondent must attest that they understand and accept all RFP terms and conditions, that all statements in their proposal are true and correct, and that the signatory has full authority to submit the proposal on behalf of the organization. The form requires notarization and includes standard fields for the respondent's official title, company name, signature, legal address, notary information, and commission expiration date.
View the file
Other files
Show all 26
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
ATTACHMENT 4: Sworn Statement of Respondent
1 | P a g e
I, being first duly sworn at _______________________________________________________, City, State
On oath, depose and say I am the ________________________________________________, Official Title
Of the Respondent, ___________________________________________________________, Name of Company
Do state the following:
I have fully and carefully examined the terms and conditions of this Request for Proposals and prepared this submission directly and only from the RFP and including all accessory data.
I attest to the facts that:
• I have reviewed the RFP, all related attachments, questions and answers, addenda, and information provided through
Milwaukee County, in detail before submitting this Proposal.
• I have indicated review, understanding and acceptance of the RFP.
• I certify that all statements within this Proposal are made on behalf of the Respondent identified above.
• I have full authority to make such statements and to submit this Proposal as the duly recognized representative of the
Respondent.
• I further stipulate that the said statements contained within this Proposal are true and correct and this sworn statement is hereby made a part of the foregoing RFP response.
Signature
Legal Address
Subscribed and sworn to before me
This _______________ day of _____________________, ____________
Notary Public, ________________________________ County
State of ____________________________________________
My commission expires ________________________________________
File details come from the government source that posted it. Updated .