Attachment-J.-Mercury-Affidavit.pdf
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- Solicitation number
- BPM057116
- Issued by
- Frederick County, Forestville CDP, Maryland
About this file
This is a Mercury Affidavit form required for state and local contract opportunities with the State of Maryland, effective July 2024. The affidavit serves as a declaration by an authorized representative of a bidding business regarding the mercury content of products being offered in response to procurement solicitations. Bidders must complete the form by identifying themselves as the authorized representative, stating their title, and providing their business name. The affidavit requires vendors to declare whether their proposed products contain mercury or do not contain mercury.
If mercury is present in the products being offered, the affidavit mandates that vendors provide supplementary documentation describing the specific product or product component containing mercury and quantifying the exact amount of mercury present with appropriate units of measurement. The affidavit explicitly acknowledges that the document will be furnished to the procurement officer and may be distributed to State of Maryland units, Maryland counties and subdivisions, other states, and the federal government. Submission of this affidavit with the bid or proposal is mandatory, and vendors affirm under penalties of perjury that all information provided is true and correct. The affidavit remains subject to applicable federal and Maryland laws, both criminal and civil, and does not supersede or waive the State of Maryland's statutory rights or remedies regarding misrepresentation or contract violations.
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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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