HQOTTS2595 Attachment K – Mercury Affidavit.pdf
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- Attached to
- SMALL PROCUREMENT-DESKTOP, LAPTOP AND TABLET
- Solicitation number
- BPM056064
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required for the State of Maryland small procurement opportunity for desktop, laptop, and tablet purchases, including ASUS monitors for user workstations. The affidavit serves as a formal declaration by an authorized representative of a bidding company regarding the mercury content of products being offered. Bidders must complete and submit the affidavit with their bid or proposal, confirming either that the products contain no mercury or, if mercury is present, providing detailed information about which product components contain mercury and the specific amounts measured in appropriate units.
The affidavit is subject to all applicable criminal and civil laws of the United States and the State of Maryland, and false statements are made under penalty of perjury. The document may be distributed to the State of Maryland, its counties and subdivisions, other states, and the federal government. Submission of this affidavit does not supersede or waive any statutory rights or remedies available to the State of Maryland or its jurisdictions regarding misrepresentation or contract violations. The authorized representative must sign and date the form, providing their name, title, and company name, and acknowledge the legal consequences of providing false information.
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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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