mercury_affidavit.pdf
PDF 32 KB Posted
- Attached to
- Dell monitors
- Solicitation number
- BPM058064
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required by the State of Maryland for the Desktop, Laptop, and Tablet 2015 Statewide Blanket Purchase Order (BPO 060B5400007). The affidavit serves as a certification document submitted by authorized business representatives regarding mercury content in products offered under this procurement. Bidders must declare whether their products contain mercury and, if applicable, identify the specific product components containing mercury and provide the exact quantity of mercury present with the corresponding unit of measure. This affidavit applies specifically to a Purchase Order Request for Proposal (PORFP J05P56600014) for Dell Monitors and is applicable to all Master Contractors awarded contracts under the referenced BPO who submit secondary competition bids.
The affidavit is a mandatory compliance document subject to the laws of the United States and the State of Maryland, with submissions made under penalties of perjury. The authorized representative executing the form must possess legal authority to bind the business and acknowledge that the affidavit may be distributed to the State of Maryland, its counties and subdivisions, other states, and the federal government. False or misleading statements in the affidavit do not waive Maryland's statutory rights or remedies and constitute potential violations of both criminal and civil law. Only Master Contractors under BPO 060B5400007 are eligible to respond to the Dell Monitors solicitation; no general vendor solicitation is conducted for this secondary competition.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Updated PORFP Dell Monitors J05P6700002.pdf | ||
| Updated Dell_P2425H_Monitors_Specs_Sheet.pdf |
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Text version
DESKTOP, LAPTOP AND TABLET 2015 - Mercury Affidavit
MERCURY AFFIDAVIT
AUTHORIZED REPRESENTATIVE THEREBY AFFIRM THAT:
I am the _________________ (Title) and the duly authorized representative of _______________________ (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.
(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 bid or 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.
Date
By: ___________________________ Signature
Print Name: _____________________________________ Authorized Representative and Affiant
Desktop, laptop and tablet 2015 - Mercury Affidavit
File details come from the government source that posted it. Updated .