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bid documents for the procurement of rice mill parts and ...

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Documents No. <strong>of</strong> copies (Indicate if original or photocopy)<br />

1. ______________________ __________________ _________________________<br />

2. ______________________ __________________ _________________________<br />

3. ______________________ __________________ _________________________<br />

4. ______________________ __________________ _________________________<br />

5. ______________________ __________________ _________________________<br />

6. ______________________ __________________ _________________________<br />

7. ______________________ __________________ _________________________<br />

That, each <strong>of</strong> <strong>the</strong> a<strong>for</strong>ementioned <strong>documents</strong> being submitted is an original copy or true<br />

<strong>and</strong> faithful reproduction or copy <strong>of</strong> <strong>the</strong> original as indicated:<br />

That, all in<strong>for</strong>mation in this Application <strong>for</strong> Eligibility <strong>and</strong> to Bid including its<br />

attachments are true <strong>and</strong> correct. And that any falsity, misrepresentations, omission or<br />

withholding <strong>of</strong> in<strong>for</strong>mation whe<strong>the</strong>r intentional or not, made <strong>the</strong>reon shall be sufficient cause<br />

or ground <strong>for</strong> automatic disqualification from eligibility to <strong>of</strong>fer, inclusion <strong>of</strong> name/ firm<br />

among <strong>the</strong> contractors blacklisted or barred from participating in future <strong>bid</strong>dings <strong>of</strong> <strong>the</strong><br />

National Food Authority, outright rejection <strong>of</strong> our <strong>bid</strong> <strong>and</strong>/or subsequent termination <strong>of</strong><br />

contract should an award have been made, without prejudice to criminal prosecution.<br />

That, if <strong>the</strong> Contract will be awarded to me/us, all equipment, facilities <strong>and</strong> supplies<br />

pledged under <strong>the</strong> contract shall not be withdrawn from <strong>the</strong> service area until completion <strong>of</strong> <strong>the</strong><br />

operation / activity <strong>and</strong>/or without written approval from <strong>the</strong> NFA.<br />

I WITESS WHEREOF, I hereby affix my signature this ______ day <strong>of</strong><br />

__________, 2013 at ______________________________.<br />

Republic <strong>of</strong> <strong>the</strong> Philippines)<br />

_____________________ )s.s.<br />

_______________________<br />

Affiant<br />

SUBSCRIBED AD SWOR to be me this ____day <strong>of</strong> ________20___ in <strong>the</strong><br />

____________, affiant exhibited to me his/her Community Tax Certificate No.<br />

_______________issued on __________at _____________.<br />

Doc. No. ____<br />

Page No. ____<br />

Book No.____<br />

Series No. ___<br />

_______________________<br />

NOTARY PUBLIC<br />

91

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