Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES

)
CITY/MUNICIPALITY OF __________ ) S. S.

AFFIDAVIT
(SOLE PROPRIETORSHIP)
1. ______________________________, of legal age, __________________, ____________________,
(Name of Affiant)
(Nationality)

(Civil Status)

Residing at _____________________________________________________ after having been duly

(Address of Affiant)

Sworn in Accordance with law, do hereby depose and state that:

1. I am the sole proprietor of _______________________________________________ with
(Name of Bidder)

Office Address at __________________________________________________________

(Address of Bidder)

2. 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 bidding for ____________________________________________________
(Name of the Project)

Of the DepEd Division of Camarines Sur.

3.

______________________________________________ is not Blacklisted or barred

(Name of Bidder)

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 herein are true and correct.
5. ___________________________________ is authorizing the Head of the Procuring
Entity
(Name of Bidder)

or its Authorized representative/s to verify all the documents submitted;

6. 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;
7. ______________________________________ complies with existing labor laws and
(Name of Bidder)

standards; and

8. ______________________________________ is aware of and has undertaken the

(Name of Bidder)

following Responsibilities as a Bidder:

a. Carefully examine all the bidding documents;
b. Acknowledge all conditions, local or otherwise, affecting the
implementation of the Contract.

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
_______________________________________________________
(Name of the Project)

IN WITNESS WHEREOF, I have hereto set my hand this ______ day of ________, 20____
at ____________________________, Philippines.

_________________________________________
Bidders Representative/Authorized
Signatory
AFFIANT
Republic of the Philippines
Province/City of ________________ s.s.
Municipality of _________________
Subscribed and sworn to before me this ______ day of ________, ___________ affiant
exhibiting his Community Tax Certificate No. _______________ issued on __________________
at _____________________.

_________________________________________
NOTARY PUBLIC
Until Dec 31, _____________
PTR No. _________________
IBP No. _________________
Roll No. _________________

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES

)
CITY/MUNICIPALITY OF __________ ) S. S.

AFFIDAVIT
(PARTNERSHIP, CORPORATION, COOPERATIVE OR JOINT VENTURE)

1. ______________________________, of legal age, __________________, ____________________,

(Name of Affiant)
(Nationality)

(Civil Status)

Residing at _____________________________________________________ after having been duly

(Address of Affiant)

Sworn in Accordance with law, do hereby depose and state that:

1. I am the duly authorized and designated representative of
___________________________
(Name of Bidder)

With office address at _____________________________________________________

(Address of Bidder)

2. I am granted full power and authority to do, execute and perform any and all
acts
necessary and/or to represent the ________________________________________ in the
(Name of Bidder)

Bidding as shown in the attached _______________________________________________

(state title of attached document showing proof or authorization (e.g. duly notarized
Secretarys Certificate issued by the corporation or the members of the joint venture)

3. ______________________________________________ is not Blacklisted or barred

(Name of Bidder)

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 herein are true and correct.
5. ___________________________________ is authorizing the Head of the Procuring
Entity
(Name of Bidder)

or its duly Authorized representative/s to verify all the documents submitted;

6. 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;
7. None of the officers, directors, and controlling stockholders of
___________________________________________is related to the Head of the
(Name of Bidder)

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;
8. ______________________________________ complies with existing labor laws and
(Name of Bidder)

standards; and

9. ______________________________________ is aware of and has undertaken the

(Name of Bidder)

following Responsibilities as a Bidder:

a. Carefully examine all the bidding documents;
b. Acknowledge all conditions, local or otherwise, affecting the
implementation of the Contract.
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
_______________________________________________________
(Name of the Project)

IN WITNESS WHEREOF, I have hereto set my hand this ______ day of ________, 20____
at ____________________________, Philippines.

_________________________________________
Bidders Representative/Authorized
Signatory
AFFIANT
Republic of the Philippines
Province/City of ________________ s.s.
Municipality of _________________
Subscribed and sworn to before me this ______ day of ________, ___________ affiant
exhibiting his Community Tax Certificate No. _______________ issued on __________________
at _____________________.

_________________________________________
NOTARY PUBLIC
Until Dec 31, _____________
PTR No. _________________
IBP No. _________________
Roll No. _________________

FINANCIAL
COMPONENT

Project Reference Number: __________________

Construction of New
(Multi-purpose)Laboratory Workshop
Building
Name of the Project:

Location of the Project: Camarines Sur,

Philippines.

BID
To:

FORM

Juan F. Trivino Memorial High School

Caranan, Pasacao, Camarines Sur

We, the undersigned declare that:

A. We have examined and have no reservation to the Bidding Documents
including
Addenda,
for
the
Contract
PURCHASE
of
______________________________________;
B. We offer to execute the works for this Contract in accordance with the Bid
and Bid Data sheet, General and Special Condition of Contract
accompanying this Bid;
C. The total price of our Bid, excluding any discounts offered in item (d)
below is: _________________________________________________________.
D. The discounts offered and the methodologies for the application are:
_________________________________________________________.
E. Our Bid shall be valid for a period of 120 days from the date fixed for the
Bid submission, deadline in accordance with the Bidding Documents, and
it shall remain binding upon us and may be accepted at any time before
the expiration of the period;
F. Our firm Bid is accepted, we commit to obtain a Performance Security in
the amount of ____________________________________________________ which
represents _____________ percent of the Contract Price for the due
Performance of the Contract;
G. We are not participating, as Bidders, in more that one Bid in this bidding
process, other than alternative offers in accordance with the bidding
documents;
H. We understand that this Bid with your written acceptance thereof included
in your notification of award, shall constitute a binding contract between
us, until a formal contract is prepared and executed; and
I. We understand that you are not bound to accept the Lowest Evaluated Bid
or any other Bid that you may receive.
NAME:

____________________________________________________________________

In the Capacity of __________________________________________________________

Signed: ___________________________________________________________________
Duly

authorized

to

sign

the

Bid

for

and

on

behalf

________________________________
Date: _____________________________________________________________________

of