Attachment-J.-Mercury-Affidavit.D7ELEC31SB.pdf
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- Solicitation number
- BPM059057
- Issued by
- Carroll County, Maryland
About this file
This is a Mercury Affidavit document required for the Electrical Maintenance & Repair Services solicitation (D7ELEC31SB) issued by the State Highway Administration (MDOT SHA) in Maryland. The affidavit must be completed and submitted with all bids and proposals and serves as a certification regarding mercury content in products offered by bidders. The document requires the authorized representative of the bidding business to declare under penalty of perjury whether the products being offered contain mercury. If mercury is present, bidders must provide a detailed attachment describing which product or component contains the mercury and specify the exact amount of mercury with the unit of measure used. The affidavit must be signed by a duly authorized representative who possesses legal authority to execute the document on behalf of the business.
The Mercury Affidavit acknowledges that the document will be furnished to the procurement officer and may be distributed to various Maryland state units, counties, subdivisions, other states, and the federal government. The affidavit is subject to all applicable United States and Maryland laws, both criminal and civil, and any misrepresentation or violation of obligations related to the affidavit or resulting contract may result in legal consequences. Bidders must submit this completed affidavit with their bid submission on emma.maryland.gov by the bid closing date of October 15th, 2026 at 12:00 PM Local Time.
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Text version
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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