Attachment-J.-Mercury-Affidavit.pdf
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- Solicitation number
- BPM057619
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form, effective July 2024, required for submission with bids and proposals to the State of Maryland and its subdivisions. The affidavit serves as a certification document whereby an authorized business representative attests under penalty of perjury regarding the mercury content of products being offered in response to procurement opportunities. The form requires the affiant to declare their name, title, and authorization to represent the business, and to specify whether the products contain mercury or do not contain mercury. If mercury is present, the affiant must provide detailed information about which product or product component contains mercury and specify the exact amount of mercury using appropriate units of measure.
The affidavit acknowledges that the document will be furnished to the procurement officer and may be distributed to units of the State of Maryland, counties and other state 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, and any misrepresentation or violation of obligations may result in legal consequences. The form must be signed and dated by the authorized representative and submitted with the bid or proposal. This particular affidavit is associated with the Maryland School for the Deaf's procurement for Cisco Meraki security cameras and licenses, which was awarded on July 2, 2026.
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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 .