Attachment_K___Mercury_Affidavit.pdf
PDF 90 KB Posted
- Attached to
- DJS Phone Upgrade 3 Location
- Solicitation number
- BPM051084
- Issued by
- Baltimore City, Maryland
About this file
The document is a Mercury Affidavit for the State of Maryland, designed to be submitted with a bid or proposal to various government units including the State of Maryland, its counties and subdivisions, other states, and the federal government. The affidavit requires an authorized representative to declare whether the product(s) being offered contain mercury, with two potential response options: (1) the products do not contain mercury, or (2) the products do contain mercury.
If mercury is present in the product, the affiant must provide additional details in an attachment, specifically describing the product or product component containing mercury and specifying the precise amount of mercury with its unit of measurement. The document emphasizes that the affidavit is subject to applicable federal and Maryland state laws, and the signatory must declare under penalty of perjury that the information provided is true and correct to the best of their knowledge, information, and belief.
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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
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