5-Bidders Affidavit.docx

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Attached to
IRON BRIDGE PUMP STATION REHABILITATION
Solicitation number
CIZ-DWU 25 523
Issued by
Uvalde County, Texas

About this file

This is a Bidder's Affidavit required by the City of Dallas under City Council Resolution #891132 for the Iron Bridge Pump Station Rehabilitation project located in Wills Point, Texas. The affidavit is a mandatory certification document that bidders must complete and submit with their bids. The project encompasses comprehensive rehabilitation work at the Dallas Water Utilities' Iron Bridge Pump Station on Lake Tawakoni, including civil work such as dredging and sediment management, structural repairs to concrete elements including flumes and guard rails, architectural improvements including roof replacement and elevator rehabilitation, process-mechanical upgrades to intake gates and pump systems, electrical rehabilitation of low-voltage and medium-voltage equipment with new generator installation, and instrumentation replacement related to process-mechanical operations.

The Bidder's Affidavit certifies that the signing corporate officer's firm maintains acceptable safety records with the Dallas OSHA office or local OSHA jurisdiction where the firm conducts business. Specifically, bidders must certify that their firm has not received six or more serious violations (with no repeat violations) or three or more willful violations (with no repeat violations) within the preceding three years. The form requires execution before a notary public with the signature of a corporate officer only, and failure or refusal to complete and submit the affidavit may result in bid rejection. The affidavit does not establish pricing terms, set-asides, or funding requirements but serves as a compliance and safety certification mechanism for bid eligibility.

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Text version

Date of Bid Opening

BIDDER'S AFFIDAVIT

The following information is required by City Council Resolution #891132.

Failure or refusal to complete this form my result in bid rejection.

The undersigned certifies that safety records from the Dallas OSHA office or the local OSHA office in which this firm does business does not reflect penalties for six (6) or more serious violations, none of which may be repeat violation, nor may it reflect three (3) or more willful violations, none of which may be repeat violations, within the preceding three (3) years.

Name of Signatory Title Address

Corporate Authorized Title Address Signatory (Only) The above signature must be by a Corporate Officer.

Legal Name of Bidder Address

SWORN TO AND SUBSCRIBED BEFORE ME on this _____ day of ______________, 20______, to certify which witness my hand and seal of this office.

NOTARY PUBLIC, STATE OF ___________

Printed Name of Notary image1.png

File details come from the government source that posted it. Updated .