Share

Omnibus Sworn Statement

NHA omnibus sworn statement for suppliers, manufacturers and distributors.

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES
)
CITY/MUNICIPALITY OF ______ ) S.S.
AFF IDAVIT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at
[Address of Affiant], after having been duly sworn in accordance with law, do hereby
depose and state that:
1. Select one, delete the other:
If a sole proprietorship: I am the sole proprietor of [Name of Bidder] with office
address at [address of Bidder];
If a partnership, corporation, cooperative, or joint venture: I am the duly
authorized and designated representative of [Name of Bidder] with office
address at [address of Bidder];
2. Select one, delete the other:
If a sole proprietorship: As the owner and sole proprietor of [Name of Bidder],
I have full power and authority to do, execute and perform any and all acts
necessary to represent it in the bidding for [NHA of the Project] of the [Name
of the Procuring Entity];
If a partnership, corporation, cooperative, or joint venture: I am granted full
power and authority to do, execute and perform any and all acts necessary
and/or to represent the [Name of Bidder] in the bidding as shown in the
attached [state title of attached document showing proof of authorization (e.g.,
duly notarized Secretary’s Certificate issued by the corporation or the
members of the joint venture)];
3. [Name of Bidder] is not “blacklisted” or barred from bidding by the
Government of the Philippines or any of its agencies, offices, corporations, or
Local Government Units, foreign government/foreign or international financing
institution whose blacklisting rules have been recognized by the Government
Procurement Policy Board;
4. Each of the documents submitted in satisfaction of the bidding requirements is
an authentic copy of the original, complete, and all statements and information
provided therein are true and correct;
5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly
authorized representative(s) to verify all the documents submitted;

6. Select one, delete the rest:
If a sole proprietorship: I am not related to the Head of the Procuring Entity,
members of the Bids and Awards Committee (BAC), the Technical Working
Group, and the BAC Secretariat, the head of the Project Management Office
or the end-user unit, and the project consultants by consanguinity or affinity
up to the third civil degree;
If a partnership or cooperative: None of the officers and members of [Name of
Bidder] is related to the Head of the Procuring Entity, members of the Bids
and Awards Committee (BAC), the Technical Working Group, and the BAC
Secretariat, the head of the Project Management Office or the end-user unit,
and the project consultants by consanguinity or affinity up to the third civil
degree;
If a corporation or joint venture: None of the officers, directors, and controlling
stockholders of [Name of Bidder] is related to the Head of the Procuring
Entity, members of the Bids and Awards Committee (BAC), the Technical
Working Group, and the BAC Secretariat, the head of the Project
Management Office or the end-user unit, and the project consultants by
consanguinity or affinity up to the third civil degree;
7. [Name of Bidder] complies with existing labor laws and standards; and
8. [Name of Bidder] is aware of and has undertaken the following responsibilities
as a Bidder:
a) Carefully examine all of the Bidding Documents;
b) Acknowledge all conditions,
implementation of the Contract;

local

or

otherwise,

affecting

the

c) Made an estimate of the facilities available and needed for the contract to
be bid, if any; and
d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Ref. No. and
Name of the Project]; and
9. [Name of Bidder] did not give or pay directly or indirectly, any commission,
amount, fee, or any form of consideration, pecuniary or otherwise, to any
person or official, personnel or representative of the government in relation to
any procurement project or activity.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__
at ____________, Philippines.

___________________________________
Bidder’s Representative/Authorized Signatory
[JURAT]
(*Must be Notarized)
 
Page of
Share