Attachment-J.-Mercury-Affidavit.pdf

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Attached to
FC0002501 – State Center Juniper EOL Upgrade
Solicitation number
BPM057112
Issued by
Maryland

About this file

This is a Mercury Affidavit form required by the State of Maryland for the FC0002501 State Center Juniper EOL Upgrade contract opportunity. The affidavit must be completed and submitted by the authorized representative of any bidding business as part of their bid or proposal response.

The affidavit requires the authorized representative to declare under penalties of perjury whether the products offered contain mercury. If products contain mercury, the bidder must provide a detailed attachment describing each product or product component containing mercury and specifying the amount of mercury present with the unit of measure used. The completed affidavit will be provided to the State of Maryland procurement officer and may be distributed to Maryland counties and subdivisions, other states, and the federal government. Bidders acknowledge that false statements in the affidavit are subject to applicable criminal and civil laws of the United States and Maryland, and that submission of the affidavit does not supersede or waive any statutory rights or remedies available to the state 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

File details come from the government source that posted it. Updated .