Attachment-J.-Mercury-Affidavit.pdf
PDF 68 KB Posted
- Solicitation number
- BPM056902
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form issued by the State of Maryland, effective July 2024, required for submission with bids and proposals to the state and its subdivisions. The affidavit serves as a declaration by an authorized business representative regarding the mercury content of products being offered in response to procurement opportunities. Bidders must complete the form by identifying whether their proposed products contain mercury or do not contain mercury. If mercury is present, vendors must provide detailed information in an attachment specifying which product or product component contains mercury and the exact amount of mercury present, including the unit of measurement.
The affidavit is executed under penalty of perjury and is subject to applicable federal and Maryland state laws, both criminal and civil. The declaration acknowledges that the document will be distributed to units within the State of Maryland, Maryland counties and subdivisions, other states, and the federal government. Signatories affirm that they possess legal authority to execute the affidavit on behalf of their business and that the information provided is true and correct to the best of their knowledge. The state reserves all statutory rights and remedies with respect to any misrepresentation or violation of obligations related to the affidavit, the resulting contract, and other contract-related documents. This affidavit requirement applies to the Cisco Hyperflex Data Platform procurement for the Maryland Longitudinal Data System Collaborative (MLDSC).
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Other files
| File | Type | Posted |
|---|---|---|
| FC0002379_PORFP_for_Cisco_Hyperflex_Data_Platform_for_MLDSC.pdf | ||
| Redacted_BOM_FC0002379.pdf |
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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
File details come from the government source that posted it. Updated .