Attachment K - Mercury Affidavit.pdf
PDF 17 KB Posted
- Solicitation number
- BPM058157
- Issued by
- Maryland
About this file
This is a Mercury Affidavit document required for the State of Maryland's Purchase Order Request for Proposal (PORFP) J05P6600023 for the Replacement of CISCO EOL Equipment. The affidavit, effective April 17, 2018, requires an authorized representative of the bidding business to certify under penalty of perjury whether the products or product components offered contain mercury. Bidders must select either that products do not contain mercury or, if they do contain mercury, provide detailed information including a description of the mercury-containing product or component and the specific amount of mercury present with the unit of measure identified.
The affidavit acknowledges that the document will be furnished to the State of Maryland's procurement officer and may be distributed to Maryland counties and subdivisions, other states, and the federal government. The submission is subject to applicable United States and Maryland laws, both criminal and civil, and does not supersede or waive any statutory rights or remedies available to the State of Maryland regarding misrepresentation or violation of contract obligations. Bidders must submit the completed and signed affidavit with their bid or proposal response.
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Other files
| File | Type | Posted |
|---|---|---|
| PORFP Spec. Sheet - Replacement of CISCO EOL Equipment.xlsx | XLSX spreadsheet | |
| PORFP J05P6600023, Replacement of CISCO EOL Equipment.pdf |
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Text version
Attachment K – Mercury Affidavit Page K-1 effective date: April 17, 2018
Attachment K. 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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