Attachment J - Mercury Affidavit.pdf
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- Solicitation number
- BPM058791
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required by the State of Maryland for the Multi-Step Invitation for Bids (MS-IFB) BPM058791/MLT2032-01 for Materials Laboratory Testing Services under the State Highway Administration (SHA). The affidavit is effective as of July 2024 and must be completed and submitted by the duly authorized representative of the bidding business with their bid or proposal. The form requires the affiant to declare under penalty of perjury whether the product(s) being offered contain mercury or are mercury-free.
If the product(s) do contain mercury, the bidder must provide a detailed attachment describing the specific product or product component containing mercury and quantifying the exact amount of mercury present with the appropriate unit of measure. The affidavit acknowledges that the document will be furnished to the State of Maryland procurement officer and may be distributed to Maryland counties and subdivisions, other states, and the federal government. All bidders are subject to applicable criminal and civil laws of the United States and Maryland regarding the truthfulness and accuracy of the affidavit, and any misrepresentation or violation of obligations related to the affidavit and resulting contract may result in legal consequences.
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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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