OMNIBUS SWORN STATEMENT
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF ALBAY : S.S.
CITY OF LIGAO)
AFFIDAVIT
I, ______________________________ of legal age, Filipino, married with residence
and postal address at ___________________________________after having been
duly sworn to in accordance with law, hereby depose and state THAT:
1. I am the sole proprietor with office address at _______________________;
2. As the owner and sole proprietor, I have full power and authority to do,
execute and perform any and all acts necessary to participate, submit the
bid, and to sign and execute the ensuing contract for the PROCUREMENT
OF CATERING SERVICES WITH VENUE FOR BUILDING HEALTHY HABITS:
STRENGTHENING HYGIENE PRACTICES TO SUPPORT SBFP IMPLEMENTATION as
shown in the attached duly notarized Special Power of Attorney;
3. __________________________, 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, by itself or by
relation, membership, association, affiliation, or controlling interest with
another blacklisted person or entity as defined and provided for in the
Uniform Guidelines on Blacklisting;
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. __________________________, is authorizing the Head of the Procuring Entity
or its duly authorized representative(s) to verify all the documents
submitted;
6. The owner or sole proprietor is 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 standards;
8. _________________________, is aware of and has undertaken the
responsibilities as a Bidder in compliance with the Philippine Bidding
Documents, which includes:
a. Carefully examining all of the Bidding Documents;
b. Acknowledging all conditions, local or otherwise, affecting the
implementation of the Contract;
c. Making an estimate of the facilities available and needed for the
contract to be bid, if any; and
d. Inquiring or securing Supplemental/Bid Bulletin(s) issued for the
PROCUREMENT OF CATERING SERVICES WITH VENUE FOR BUILDING HEALTHY
HABITS: STRENGTHENING HYGIENE PRACTICES TO SUPPORT SBFP
IMPLEMENTATION.
9. _______________________________, 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; and,
10. In case advance payment was made or given, failure to perform or deliver
any of the obligations and undertakings in the contract shall be sufficient
grounds to constitute criminal liability for Swindling (Estafa) or the
commission of fraud with unfaithfulness or abuse of confidence through
misappropriating or converting any payment received by a person or entity
under an obligation involving the duty to deliver certain goods or services,
to the prejudice of the public and the government of the Philippines
pursuant to Article 315 of Act No. 3815 s. 1930, as amended, or the Revised
Penal Code.
IN WITNESS WHEREOF, I am affixing my signature this ______ day of _____, 2025 in
Ligao City, Albay.
______________________________
Affiant
Valid ID: ___________________________________
SUBSCRIBED AND SWORN TO BEFORE ME, this day _____ of ______, 2025 at
______________________, Affiant, who proved to me on the basis of competent
evidence of identity as above described, to be the person who appeared before me.
__________________________
NOTARY PUBLIC
Doc. No. _______
Page No. ______
Book No. ______
Series of _______
