5-Attachment D-2 Combined Corporate Accountability and Workforce Safety Affidavit 3-21-2024.pdf
PDF 111 KB Posted
- Attached to
- RFP Fire Capital Improvements
- Solicitation number
- 540926
- Issued by
- Wayne County, Detroit City, Michigan
About this file
This is a Combined Affidavit of Workforce Safety and Corporate Accountability required by the City of Detroit Office of Contracting and Procurement (OCP) in conjunction with an RFP for Fire Capital Improvements construction services. The affidavit must be completed and notarized by a Chief Executive Officer or authorized designee of the contracting organization and submitted as part of the proposal process for construction services to be rendered at firehouse locations throughout Detroit over a two-year contract period.
The affidavit requires the contractor to attest under oath to compliance with specific workforce safety and corporate accountability standards. Workforce safety requirements mandate that all employees and subcontractors handling hazardous materials complete hazardous materials awareness training in accordance with state and federal guidelines, and that all craft labor personnel complete the OSHA 10-hour construction training course. Corporate accountability requirements obligate the contractor to represent that it holds all required licenses, registrations, and certificates for the work; has not had any required credentials revoked within the past five years; and has not been debarred by any federal, state, or local governmental agency within the past three years. The City of Detroit treats any misstatement or false representation in the affidavit as fraudulent activity under City Ordinance 17-5-12(g)(1) and Michigan Criminal Law MCL 750.249. Notarization of the document is mandatory, and the affidavit must be received and cleared by OCP before contract award eligibility is determined.
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Text version
Version 3/21/2024
COMBINED AFFIDAVIT
OF
WORKFORCE SAFETY &
CORPORATE ACCOUNTABILITY
Contract No:_____________
I am , and state under oath:
I am the [INSERT OFFICER TITLE HERE] of [INSERT NAME OF ORGANIZATION]
(“Contractor”), and represent that I am authorized to execute this affidavit on behalf of the
Contractor, and its owners, directors, and officers. I am the Chief Executive Officer, or authorized designee, and attest to the Contractor’s compliance with the following requirements:
A. I represent that the following statements regarding Workforce Safety are true:
(1) All employees and subcontractors handling or interacting with hazardous materials have been properly trained, through completion in hazardous materials awareness training; or participation and completion in the requisite awareness training program compliant with state and federal guidelines; and
(2) All employees and subcontractors providing craft labor have at a minimum completed the OSHA 10-hour construction training course for safety established by the U.S. Department of Labor, Occupational Safety and Health Administration.
B. I also represent that the following statements regarding Corporate Accountability are true:
(1) The Contractor and its employees have the required licenses, registrations, and certificates required to perform the work as stated in the solicitation; and
(2) The Contractor has not had any licenses, registrations, or certificates which are required for the performance of the contract revoked in the past five (5) years; and
(3) The Contractor has not been debarred by any federal, state or local governmental agency or authority in the past three (3) years.
I understand and acknowledge that the above representations are material and important and will be relied upon by the City of Detroit in determining the Contractor’s eligibility for this contract(s)/purchase order(s). I understand and acknowledge, and the Contractor understands and acknowledges that the City of Detroit will treat any misstatement or false representation in this affidavit as a fraudulent activity relating to the eligibility of award for this contract(s)/purchase order(s) under City Ordinance 17-5-12 (g)(1), with intent to defraud the City of Detroit pursuant to MCL 750.249.
Version 3/21/2024
**This Document MUST be
Notarized**
Complete the section below
Printed Name & Title of Authorized Representative:
Signature of Authorized Representative:
Date:
This document was acknowledged, subscribed, and sworn before me <INSERT DATE HERE> day of <INSERT MONTH HERE>, 20XX, by <INSERT NAME OF AUTHORIZED AGENT HERE>, the <INSERT OFFICER TITLE HERE> of <INSERT NAME OF ORGANIZATION HERE>.
Signature of Notary:
Printed Name of Seal of Notary:
My Commission Expires: / /
THIS SECTION IS FOR OCP USE ONLY:
Affidavits Received & Clearance Date: ______________
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