MercuryAffidavit.pdf
PDF 76 KB Posted
- Attached to
- J02P4600016 - Patton Electronics
- Solicitation number
- BPM040137
- Issued by
- Maryland
About this file
This document is an Affidavit related to the mercury content of products associated with a state and local government contract opportunity in Maryland. The Affidavit requires the authorized representative of the business to affirm whether the offered product(s) contain mercury and, if so, to describe the product component and provide the amount of mercury. This Affidavit may be distributed to the State of Maryland, its counties and subdivisions, other states, and the federal government. The related contract opportunity is for the purchase of Copper interconnect cable and Cellular Modems to be used in a traffic signal system that helps manage congestion and provides remote troubleshooting capabilities for technicians.
The Affidavit states that the contents of the document are true and correct to the best of the authorized representative's knowledge, information, and belief, and that nothing in the Affidavit or resulting contract shall supersede, amend, modify, or waive the State of Maryland's constitutional and statutory rights and remedies with respect to any misrepresentations or violations of the contract terms and covenants.
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Other files
| File | Type | Posted |
|---|---|---|
| J02P4600016 Patton Electronics Bid Form.xlsx | XLSX spreadsheet | |
| NO BID FORM.pdf | ||
| J02P4600016 Patton Electronics PORFP.docx | DOCX document |
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Text version
ATTACHMENT H – 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
ATTACHMENT H – Mercury Affidavit
File details come from the government source that posted it. Updated .