Mercury_Affidavit.pdf
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- Attached to
- Nutanix Server
- Solicitation number
- BPM055539
- Issued by
- Maryland
About this file
This is a Mercury Affidavit form required for the Hardware 2012 Master Contract (060B2490022) administered by the State of Maryland. The affidavit serves as a disclosure document for authorized business representatives to declare whether products being offered contain mercury. Bidders must indicate whether their product offerings contain no mercury or identify specific product components containing mercury and quantify the exact amount with appropriate units of measure. The form is designed for use in secondary competitions, including Purchase Order Requests for Proposals (PORFPs), and applies specifically to SBR Master Contractors awarded under the Hardware and associated equipment and service 2012 Master Contract.
The affidavit carries significant legal weight, as the authorized representative executing the document does so under penalties of perjury and acknowledges that false statements are subject to both criminal and civil penalties under federal and Maryland law. The completed affidavit will be provided to the procurement officer and may be distributed to the State of Maryland, Maryland counties and subdivisions, other states, and the federal government. The affidavit does not supersede existing statutory rights or remedies available to Maryland or its jurisdictions regarding contract performance, misrepresentation, or breach of obligations. Submission of this affidavit is mandatory for bid consideration under the Hardware 2012 Master Contract procurement.
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Text version
HARDWARE 2012 - 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.
________________ By: ___________________________ Date Signature
Print Name: _____________________________________ Authorized Representative and Affiant
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