Attachment-J.-Mercury-Affidavit__3_.pdf

68 KB Posted

Attached to
Automatic Transfer Switch and Disconnect Installations at theVictor Cullen Center (Cancelled)
Solicitation number
BPM056964
Issued by
Frederick County, Maryland

About this file

Written by GovTribe AI ·

This is a Mercury Affidavit form required by the State of Maryland for the Automatic Transfer Switch and Disconnect Installations project at the Victor Cullen Center. The affidavit serves as a certification document that bidders must submit with their bid or proposal to disclose whether the products being offered contain mercury. Bidders are required to indicate whether their offered products do or do not contain mercury, and if mercury is present, they must provide detailed information in an attachment specifying which product or product component contains mercury and the exact amount of mercury contained within the product, including the unit of measure.

The affidavit is completed and signed by an authorized representative of the bidding business who possesses legal authority to make the certification on behalf of the company. The affiant acknowledges that the document will be provided to the procurement officer and may be distributed to Maryland state units, Maryland counties or subdivisions, other states, and the federal government. The affidavit is subject to all applicable criminal and civil laws of the United States and the State of Maryland, with violations potentially resulting in legal consequences for any misrepresentation or breach of the obligations outlined in the affidavit and resulting contract.

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Attachment J – Mercury Affidavit Effective Date: July 2024

Attachment J. Mercury Affidavit

AUTHORIZED REPRESENTATIVE THEREBY AFFIRM THAT:

I, _______________________________ (name of affiant) am the _______________________________ (title) and the duly authorized representative of _______________________________ (name of the 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.

� In an attachment to this Mercury Affidavit:

(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 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

SUBMIT THIS AFFIDAVIT WITH BID/PROPOSAL

Attachment K. Mercury Affidavit

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