4._Attachment_A_-_Mercury_Affidavit.pdf
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- Attached to
- Kodak Scanners and Flatbed Accessories
- Solicitation number
- BPM057032
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required by the State of Maryland for the Hardware 2012 procurement opportunity related to Kodak Scanners and Flatbed Accessories. The affidavit serves as a declaration by an authorized representative of a bidding business regarding the mercury content of products being offered. Bidders must indicate whether their proposed products contain mercury and, if applicable, identify the specific product components containing mercury and quantify the amount of mercury present with corresponding units of measure.
The affidavit is a legally binding document subject to applicable federal and state laws of Maryland, both criminal and civil. Bidders acknowledge that the completed form will be furnished to the procurement officer and may be distributed to the State of Maryland, Maryland counties or subdivisions, other states, and the federal government. The affiant must solemnly declare under penalties of perjury that all information provided is true and correct, with the understanding that any misrepresentation or violation of obligations, terms, and covenants set forth in the affidavit, contract, or related documents may result in legal consequences.
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Text version
HARDWARE 2012 - Mercury Affidavit
MERCURY AFFIDAVIT
AUTHORIZED REPRESENTATIVE THEREBY AFFIRM THAT:
I am the _________________ (Title) and the duly authorized representative of _______________________ (Business). I possess the legal authority to make this affidavit on behalf of myself and the business for which I am acting.
MERCURY CONTENT INFORMATION:
[ ] The product(s) offered do not contain mercury.
OR
[ ] The product(s) offered do contain mercury.
(1) Describe the product or product component that contains mercury.
(2) Provide the amount of mercury that is contained in the product or product component. Indicate the unit of measure being used.
I ACKNOWLEDGE THAT this affidavit is to be furnished to the procurement officer and may be distributed to units of (1) the State of Maryland; (2) counties or other subdivisions of the State of Maryland;
(3) other states; and
(4) the federal government. I further acknowledge that this Affidavit is subject to applicable laws of the United States and the State of Maryland, both criminal and civil, and that nothing in this affidavit or any contract resulting from the submission of this bid or proposal shall be construed to supersede, amend, modify, or waive, on behalf of the State of Maryland, or any unit of the State of Maryland having jurisdiction, the exercise of any statutory right or remedy conferred by the Constitution and the laws of Maryland with respect to any misrepresentation made or any violation of the obligations, terms and covenants undertaken by the above business with respect to (1) this affidavit, (2) the contract, and (3) other affidavits comprising part of the contract.
I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT
THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE, INFORMATION, AND BELIEF.
________________ By: ___________________________ Date Signature
Print Name: _____________________________________ Authorized Representative and Affiant
Hardware 2012 - Mercury Affidavit
File details come from the government source that posted it. Updated .