S-44300-00013646 Attachment B Disclosure Exemption Affidavit-word form for use~1.docx
DOCX document 36 KB Posted
- Attached to
- RFP Medicare Cost Report
- Solicitation number
- S-44300-00013646
- Issued by
- Marion County, Oregon
About this file
This is a Disclosure Exemption Affidavit template issued by the State of Oregon Department of Administrative Services (DAS) Procurement Services for use in responding to Oregon Buys intermediate procurements. The document serves as a formal mechanism for offerors to identify and justify information within their bids that they believe should be withheld from public disclosure under Oregon's Public Records Law (ORS 192.311-192.478) or the Uniform Trade Secrets Act (ORS 646.461-646.475). The affidavit requires a sworn statement from an authorized company representative affirming familiarity with the procurement, the submitted offer, and the exemption provisions, with the exemption claim detailed in Exhibit A. The document is notarized and includes signature lines for both the affiant and a notary public.
The affidavit permits offerors to claim exemptions for proprietary information, trade secrets, and confidential business data that meet specific criteria—including formulas, processes, production data, customer lists, cost data, or other compilations that are not publicly known, provide competitive advantage, have actual or potential commercial value, and are subject to reasonable secrecy measures by the company. The template indicates this procedure applies to the Medicare Cost Report procurement (Oregon Buys Bid # S-44300-00013646) and establishes that any disclosure of claimed exempt information remains subject to official or judicial determinations under Oregon Public Records Law. The affidavit form was finalized on August 16, 2021, and serves as a standard tool for all DAS intermediate procurements.
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Text version
ATTACHMENT B — disclosure exemption AFFIDAVIT ____________________ (Affiant), being first duly sworn under oath, and representing [insert Offeror Name] (hereafter “Offeror”), hereby deposes and swears or affirms under penalty of perjury that:
I am an employee of the Offeror, I have knowledge of the Intermediate Procurement referenced herein, and I have full authority from the Offeror to submit this affidavit and accept the responsibilities stated herein.
I am aware that the Offeror has submitted an Offer, dated on or about [insert date] (the “Offer”), to the State of Oregon (State) in response to Intermediate Procurement [insert Oregon Buys Bid #], for [insert description of Intermediate Procurement], and I am familiar with the contents of the Intermediate Procurement and Offer.
I have read and am familiar with the provisions of Oregon’s Public Records Law, Oregon Revised Statutes (“ORS”) 192.311 through 192.478, and the Uniform Trade Secrets Act as adopted by the State of Oregon, which is set forth in ORS 646.461 through ORS 646.475. I understand that the Offer is a public record held by a public body and is subject to disclosure under the Oregon Public Records Law unless specifically exempt from disclosure under that law.
I have reviewed the information contained in the Offer. The Offeror believes the information listed in Exhibit A is exempt from public disclosure (collectively, the “Exempt Information”), which is incorporated herein by this reference. It is my opinion that the Exempt Information is exempt from disclosure under Oregon’s Public Records Law under the specifically designated sections as set forth in Exhibit A or constitutes “Trade Secrets” under either the Oregon Public Records Law or the Uniform Trade Secrets Act as adopted in Oregon because that information is either:
A formula, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information that:
is not patented, is known only to certain individuals within the Offeror’s organization and that is used in a business the Offeror conducts, has actual or potential commercial value, and gives its user an opportunity to obtain a business advantage over competitors who do not know or use it.
or Information, including a drawing, cost data, customer list, formula, pattern, compilation, program, device, method, technique or process that:
Derives independent economic value, actual or potential, from not being generally known to the public or to other persons who can obtain economic value from its disclosure or use; and Is the subject of efforts by the Offeror that are reasonable under the circumstances to maintain its secrecy.
I understand that disclosure of the information referenced in Exhibit A may depend on official or judicial determinations made in accordance with the Public Records Law.
Affiant’s Signature State of ___________) ) ss:
County of ________) Signed and sworn to before me on ___________ (date) by ______________________ (Affiant’s name).
Notary Public for the State of _________________ OregonBuys Bid # S-44300-00013646 Medicare Cost Report Att B
My Commission Expires: _________
| RFP [###-####-##] – [RFP title] | Page 1 of 3 |
| DAS Procurement Services, Version 1.0 – August 16, 2021 | Page 3 of 3 |
EXHIBIT A TO ATTACHMENT B
Offeror identifies the following information as exempt from public disclosure under the following designated exemption(s):
File details come from the government source that posted it. Updated .