contract frm -1 NewContractAffidavit.pdf

COMAR 21.07.01.25

CONTRACT AFFIDAVIT

Exhibit ___________________ Bid Proposal #_________________

A. AUTHORIZED REPRESENTATIVE

I HEREBY AFFIRM THAT:

I am the (title) _____________________________________________________________________________ and the duly authorized representative of (business) _______________________________________________________ and that I possess the legal authority to make this Affidavit on behalf of myself and the business for which I am acting.

B. CERTIFICATION OF CORPORATION REGISTRATION AND TAX PAYMENT

I FURTHER AFFIRM THAT:

1. The business named above is a (domestic_____) (foreign_____) corporation registered in accordance with the Corporations and Associations Article, Annotated Code of Maryland, and that it is in good standing and has filed all of its annual reports, together with filing fees, with the

Maryland State Department of Assessments and T axation, and that the name and address of its resident agent filed with the State Department of Assessments and T axation is:

Name: _______________________________________________________________________

Address: _______________________________________________________________________

2. Except as validly contested, the business has paid, or has arranged for payment of, all taxes due the

State of Maryland and has filed all required returns and reports with the Comptroller of the

Treasury, the State Department of Assessments and Taxation, and the Department of Labor, Licensing, and Regulation, as applicable, and will have paid all withholding taxes due the State of

Maryland prior to final settlement.

C. CERTAIN AFFIRM ATIONS VA LID

I FURTHER AFFIRM THAT:

To the best of my knowledge, information, and belief, each of the affirmations, certifications, or acknowledgments contained in that certain Bid/Proposal Affidavit dated ________ , 20___ , and executed by me for the purpose of obtaining the contract to which this Exhibit is attached remains true and correct in all respects as if made as of the date of this Contract Affidavit and as if fully set forth herein.

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.

Date: ______________________________ By: ___________________________________________________________________ (Authorized Representative and Affiant)

(Printed or Typed Name)

DGS 360-17 (rev 5/05)