Attachment-J.-Mercury-Affidavit.pdf
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- Solicitation number
- BPM056994
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required by the State of Maryland for the Juniper MX Modernization Project – Phase II procurement. The affidavit must be completed and submitted by an authorized representative of the bidding business along with the bid or proposal. The form requires the affiant to declare under penalty of perjury whether the product(s) being offered contain mercury or are mercury-free. If mercury is present in any product or component, the affidavit must include a detailed attachment specifying which product or component contains mercury and the exact amount of mercury present, including the unit of measure. The document is effective as of July 2024 and serves as a binding declaration subject to both federal and Maryland state law.
The affidavit acknowledges that the submission will be distributed to the State of Maryland, Maryland counties and subdivisions, other states, and the federal government. Bidders are subject to applicable criminal and civil laws of the United States and Maryland, and any misrepresentation or violation of the affidavit's terms may result in legal consequences. The authorized representative must sign and date the completed form, providing their printed name and title, and submit it as part of the complete bid package to the procurement officer.
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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 .