Attachment-J.-Mercury-Affidavit.pdf
PDF 68 KB Posted
- Solicitation number
- BPM057074
- Issued by
- Maryland
About this file
This is a Mercury Affidavit document required for the Maryland FiRST VERTIV UPS Battery Replacement contract opportunity (FC0002527) with the State of Maryland. The affidavit must be completed by an authorized representative of the bidding business and submitted with the bid or proposal. The document requires the affiant to declare under penalty of perjury whether the product(s) being offered contain mercury or do not contain mercury. If mercury is present, the bidder must provide a detailed attachment describing the specific product or product component containing mercury and the exact amount of mercury contained, including the unit of measure.
The affidavit acknowledges that the document will be furnished to the State of Maryland procurement officer and may be distributed to Maryland counties and subdivisions, other states, and the federal government. The submission is subject to all applicable laws of the United States and the State of Maryland, both criminal and civil. Bidders are advised that any misrepresentation or violation of the affidavit's obligations may result in legal consequences, and the State of Maryland retains all statutory rights and remedies available under the Maryland Constitution and state law. The affidavit must be signed, dated, and include the printed name and title of the authorized representative making the declaration.
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Other files
| File | Type | Posted |
|---|---|---|
| FC0002527_PORFP_for_VERTIV_UPS_Battery_Replacement.docx | DOCX document |
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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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