Mandatory contract addendum. The contract addendum shall be
in substantially the same form as follows and submitted upon initial award and
each renewal thereafter:
CONTRACT AFFIDAVIT
A. AUTHORITY
I HEREBY AFFIRM THAT:
I, (print name) ___________________________ possess the legal
authority to make this Affidavit.
B. CERTIFICATION OF REGISTRATION OR
QUALIFICATION WITH THE STATE DEPARTMENT OF ASSESSMENTS AND TAXATION
I FURTHER AFFIRM THAT:
The business named above is a (check applicable
items):
(1) Corporation - ___ domestic
or ___ foreign;
(2) Limited
Liability Company - ___ domestic or ___ foreign;
(3) Partnership - ___ domestic or ___
foreign;
(4) Statutory Trust - ___
domestic or ___ foreign;
(5) ___
Sole Proprietorship and is registered or qualified as required under Maryland
Law.
I further affirm that the above business is in good standing
both in Maryland and (IF APPLICABLE) in the jurisdiction where it is presently
organized, and has filed all of its annual reports, together with filing fees,
with the Maryland State Department of Assessments and Taxation. The name and
address of its resident agent (IF APPLICABLE) filed with the State Department
of Assessments and Taxation is:
Name and Department ID
Number:____________________ Address:__________________
and that if it does business under a trade name, it has
filed a certificate with the State Department of Assessments and Taxation that
correctly identifies that true name and address of the principal or owner
as:
Name and Department ID Number:
________________________
Address:
_____________________________________________.
C. FINANCIAL
DISCLOSURE AFFIRMATION :
I FURTHER AFFIRM THAT
I am aware of, and the above business will comply with, the
provisions of State Finance and Procurement Article, § 13 - 221, Annotated
Code of Maryland, which require the business to file with the Secretary of
State of Maryland certain specified information, including disclosure of
beneficial ownership of the business, within 30 days of the date the aggregate
value of any contracts, leases, or other agreements that the business enters
into with the State of Maryland or its agencies during a calendar year reaches
$200,000.
D. POLITICAL
CONTRIBUTION DISCLOSURE AFFIRMATION
I FURTHER AFFIRM THAT:
I am aware of, and the above business will comply with,
Election Law Article, Title 14, Annotated Code of Maryland, which requires that
every person that enters into a procurement contract with the State, a county,
a municipal corporation, or other political subdivision of the State, during a
calendar year in which the person receives a contract with a governmental
entity in the amount of $200,000 or more shall file with the State Board of
Elections statements disclosing:
(a)
any contributions made during the reporting period to a candidate for elective
office in any primary or general election; and
(b) the name of each candidate to whom one or
more contributions in a cumulative amount of $500 or more were made during the
reporting period.
The statement shall be filed with the
State Board of Elections:
(a)
before execution of a contract by the State, a county, a municipal corporation,
or other political subdivision of the State, and shall cover the 24 months
prior to when a contract was awarded; and
(b) if the contribution is made after the
execution of a contract, then twice a year, throughout the contract term, on:
(i) May 31, to cover the six (6) month period
ending April 30; and
(ii) November
30, to cover the six (6) month period ending October 31.
E. DRUG AND ALCOHOL FREE
WORKPLACE
(Applicable to all contracts unless the contract is for a law
enforcement agency and the agency head or the agency head's designee has
determined that application of COMAR 21.11.08 and this certification would be
inappropriate in connection with the law enforcement agency's undercover
operations.)
I CERTIFY THAT:
(1)
Terms defined in COMAR
21.11.08 shall have the same meanings when used in this
certification.
(2) By submission of
its bid or offer, the business, if other than an individual, certifies and
agrees that, with respect to its employees to be employed under a contract
resulting from this solicitation, the business shall:
(a) Maintain a workplace free of drug and
alcohol abuse during the term of the contract;
(b) Publish a statement notifying its
employees that the unlawful manufacture, distribution, dispensing, possession,
or use of drugs, and the abuse of drugs or alcohol is prohibited in the
business' workplace and specifying the actions that will be taken against
employees for violation of these prohibitions;
(c) Prohibit its employees from working under
the influence of drugs or alcohol;
(d) Not hire or assign to work on the
contract anyone who the business knows, or in the exercise of due diligence
should know, currently abuses drugs or alcohol and is not actively engaged in a
bona fide drug or alcohol abuse assistance or rehabilitation program;
(e) Promptly inform the
appropriate law enforcement agency of every drug-related crime that occurs in
its workplace if the business has observed the violation or otherwise has
reliable information that a violation has occurred;
(f) Establish drug and alcohol abuse
awareness programs to inform its employees about:
(i) The dangers of drug and alcohol abuse in
the workplace;
(ii) The business's
policy of maintaining a drug and alcohol free workplace;
(iii) Any available drug and alcohol
counseling, rehabilitation, and employee assistance programs; and
(iv) The penalties that may be imposed upon
employees who abuse drugs and alcohol in the workplace;
(g) Provide all employees engaged in the
performance of the contract with a copy of the statement required by
§E(2)(b), of this regulation;
(h) Notify its employees in the statement
required by §E(2)(b), of this regulation, that as a condition of continued
employment on the contract, the employee shall:
(i) Abide by the terms of the statement;
and
(ii) Notify the employer of any
criminal drug or alcohol abuse conviction for an offense occurring in the
workplace not later than 5 days after a conviction;
(i) Notify the procurement officer within 10
days after receiving notice under §E(2)(h)(ii), of this regulation, or
otherwise receiving actual notice of a conviction;
(j) Within 30 days after receiving notice
under §E(2)(h)(ii), of this regulation, or otherwise receiving actual
notice of a conviction, impose either of the following sanctions or remedial
measures on any employee who is convicted of a drug or alcohol abuse offense
occurring in the workplace:
(i) Take
appropriate personnel action against an employee, up to and including
termination; or
(ii) Require an
employee to satisfactorily participate in a bona fide drug or alcohol abuse
assistance or rehabilitation program; and
(k) Make a good faith effort to maintain a
drug and alcohol free workplace through implementation of §E(2)(a)-(j), of
this regulation.
(3) If
the business is an individual, the individual shall certify and agree as set
forth in §E(4), of this regulation, that the individual shall not engage
in the unlawful manufacture, distribution, dispensing, possession, or use of
drugs or the abuse of drugs or alcohol in the performance of the contract.
(4) I acknowledge and agree that:
(a) The award of the contract is conditional
upon compliance with COMAR
21.11.08 and this certification;
(b) The violation of the provisions of COMAR
21.11.08 or this certification shall be cause to suspend payments under, or
terminate the contract for default under COMAR
21.07.01.11 or
21.07.03.15, as applicable; and
(c) The violation of the
provisions of COMAR
21.11.08 or this certification in connection with the
contract may, in the exercise of the discretion of the Board of Public Works,
result in suspension and debarment of the business under COMAR
21.08.03.
F.
CERTAIN AFFIRMATIONS VALID
I FURTHER AFFIRM THAT:
To the best of my knowledge, information, and belief, each
of the affirmations, certifications, or acknowledgements contained in that
certain Bid/Proposal Affidavit dated ________, 20___, and executed by me for
the purpose of obtaining the contract to which this Exhibit is attached remains
true and correct in all respects as if made as of the date of this Contract
Affidavit and as if fully set forth herein.
I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF
PERJURY THAT THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF
MY KNOWLEDGE, INFORMATION, AND BELIEF.
Date:_______
By:___________________________ (printed name of Authorized
Representative and affiant)
___________________________(signature of Authorized
Representative and affiant)