Attachment-J.-Mercury-Affidavit (5).pdf

68 KB Posted

Attached to
Commercial Doors and Window Replacement Victor Cullen Center
Solicitation number
BPM058570
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 Commercial Doors and Window Replacement project at Victor Cullen Center (VCC), a secure treatment facility for Department of Juvenile Services (DJS) youth located in Sabillasville, Maryland. The affidavit must be completed and submitted by an authorized representative of any bidding company as part of their bid or proposal. The form requires the affiant to declare under penalty of perjury whether the products being offered contain mercury, and if they do, to provide a detailed attachment specifying which product or component contains mercury and the exact amount of mercury present, including the unit of measure. The affidavit is effective as of July 2024 and serves as a binding declaration subject to applicable federal and state laws.

The completed affidavit will be distributed to the procurement officer and may be shared with the State of Maryland, its counties and subdivisions, other states, and the federal government. Bidders acknowledge that any misrepresentation or violation of the affidavit's terms subjects them to both criminal and civil penalties under Maryland and federal law. The affidavit does not supersede, amend, or modify any statutory rights or remedies available to the State of Maryland or its jurisdictions. Submission of this affidavit with the bid or proposal is mandatory for participation in the procurement process for the commercial doors and window replacement project at VCC.

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Other files

File Type Posted
APPENDIX 3.pdf PDF
Attachment-L.-Reference-Checks (4).pdf PDF
IFB BPM058570.pdf PDF
Attachment-2.-Pre-Bid_-Pre-Proposal-Conference-Response-Form-v2 (4).pdf PDF
Attachment D - MBE_Forms - Effective 9-1-26.pdf PDF
Attachment U. Contract Affidavit August 2026.pdf PDF
Appendix 6.pdf PDF
IFB Supplemental Facilities Maintenance Supplemental Commercial Doors and Windows.pdf PDF
Appendix-4A.pdf PDF
Appendix_1 .pdf PDF
Attachment B Price Form).xlsx XLSX spreadsheet
Exhibit-1.-MBE-VSBE-and-SBR-Research-Factors-Template_VCC.pdf PDF
Attachment-G.-Maryland-Living-Wage-Requirements-Affidavit-of-Agreement.pdf PDF
Attachment D-1A .pdf PDF
Attachment-F.-Bidder-Offeror-Information-Sheet (2).pdf PDF
Appendix 2.pdf PDF
Attachment-N.-Legal-Action-Summary (1).pdf PDF
Appendix 4 .pdf PDF
Exhibit-2-Sample-Contract.pdf PDF
Attachment-1.-No-Bid_Proposal-Notice_Vendor-Feedback-Form-1-1.docx DOCX document
Attachment P. Prime Contractor List of ALL Subcontractors.v2.2026 (1).xlsx XLSX spreadsheet
Attachment-M.-List-of-Current-or-Prior-State-Contracts (6).pdf PDF
Attachment-A.-Bid-Proposal-Affidavit (7).pdf PDF
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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

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