Attachment-J.-Mercury-Affidavit.pdf
PDF 68 KB Posted
- Solicitation number
- BPM059384
- Issued by
- Anne Arundel County, 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 related to procurement FC0003807 for APC Equipment – DVMF LAN – Symmetra Backup. The affidavit must be completed and signed by an authorized representative of the bidding business and submitted with the bid or proposal package. The form requires the affiant to declare under penalties of perjury whether the product or products being offered contain mercury or do not contain mercury. If mercury is present in any product or component, the bidder must provide a detailed description of the specific product or component containing mercury and specify the exact amount of mercury present with the corresponding unit of measure.
The affidavit acknowledges that the completed form will be furnished to the Maryland procurement officer and may be distributed to Maryland state units, Maryland counties or other subdivisions, other states, and the federal government. Bidders are advised that the affidavit is subject to all applicable criminal and civil laws of the United States and the State of Maryland, and that any misrepresentation or violation of obligations related to the affidavit or resulting contract may be subject to legal remedies available to the State of Maryland and its authorized jurisdictions. The affidavit becomes effective as of July 2024 and must be completed with the affiant's printed name, signature, title, business name, and date before submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| FC0003807 PORFP for APC.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .