Attachment-J.-Mercury-Affidavit.pdf
PDF 68 KB Posted
- Solicitation number
- BPM055751
- Issued by
- Montgomery County, Robinwood CDP, Maryland
About this file
This is a Mercury Affidavit form required by the State of Maryland for submission with bids or proposals on state and local contract opportunities, specifically for the CIENA - AMR On-Net Expansion project at DHS MG351 (51 Monroe St.). The affidavit serves as a declaration by an authorized representative of a bidding business regarding the mercury content of products being offered. Bidders must complete the form by identifying whether their products contain mercury or do not contain mercury. If mercury is present, the affiant must provide a detailed attachment describing which product or product component contains mercury and specifying the exact amount of mercury present, including the unit of measure used. The affidavit is effective as of July 2024 and must be submitted as part of the proposal package.
The affidavit is executed under penalty of perjury and binds the signatory to the accuracy of the declaration under applicable federal and Maryland law. The State of Maryland reserves the right to distribute this affidavit to counties and subdivisions within Maryland, other states, and the federal government. By submitting the affidavit, the vendor acknowledges that the State of Maryland retains all statutory rights and remedies regarding any misrepresentation or violation of obligations related to the affidavit, resulting contract, and other contract-related affidavits.
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Other files
| File | Type | Posted |
|---|---|---|
| FC0001943 PORFP CIENA.pdf | ||
| Redacted BOM.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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