Bid Securing Declaration Form
_________________________________________________________________________
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF _____________ ) S.S.
BID SECURING DECLARATION
Project Title: INSTALLATION OF 40 WATER METER CLUSTERS (6 WATER METERS / CLUSTER) IN
BARANGAY MAYAG, SISON SURIGAO DEL NORTE
To: Barangay Government of San Isidro
Barangay Hall, Barangay Mayag, Sison, Surigao del Norte
I/We, the undersigned, declare that:
1. I/We understand that, according to your conditions, bids must be supported by a Bid Security, which
may be in the form of a Bid Securing Declaration.
2. I/We accept that: (a) I/we will be automatically disqualified from bidding for any procurement contract
with any procuring entity for a period of two (2) years upon receipt of your Blacklisting Order; and, (b)
I/we will pay the applicable fine provided under Section 6 of the Guidelines on the Use of Bid Securing
Declaration, within fifteen (15) days from receipt of the written demand by the procuring entity for the
commission of acts resulting to the enforcement of the bid securing declaration under Sections 23.1(b),
34.2, 40.1 and 69.1, except 69.1(f),of the IRR of RA No. 9184; without prejudice to other legal action the
government may undertake.
3. I/We understand that this Bid Securing Declaration shall cease to be valid on the following
circumstances:
a. Upon expiration of the bid validity period, or any extension thereof pursuant to your request;
b. I am/we are declared ineligible or post-disqualified upon receipt of your notice to such effect, and (i)
I/we failed to timely file a request for reconsideration or (ii) I/we filed a waiver to avail of said right;
and
c. I am/we are declared the bidder with the Lowest Calculated Responsive Bid, and I/we have
furnished the performance security and signed the Contract.
IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this 27 th day of December 2024 at
Surigao City.
ARIEL ROSALES
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of December, 2024 at ____________,
Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent
evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s
exhibited to me his/her Tax Identification Number with his/her photograph and signature appearing thereon,
with no. 119- 536-150-000 and his/her Community Tax Certificate No.07575529 issued on September 02,
2024 at Butuan City
Witness my hand and seal this ___day of December, 2024
Doc. No.________
Page No.________
Book No.________
Series of 2024