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Omnibus Sworn Statement (Revised)

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Omnibus Sworn Statement

___________________________________________________________________
______

REPUBLIC OF THE PHILIPPINES

CITY/MUNICIPALITY OF TUGUEGARAO CTY, CAGAYAN S.S.

AFFIDAVIT
I, DOMINGO EGON Q. CAYOSA, of legal age, MARRIED, FIILIPINO, and residing
at #1 CAYOSA HOMES, PENGUE RUYU, TUGUEGARAO CITY, CAGAYAN, after
having been duly sworn in accordance with law, do hereby depose and state that:

1. I am the sole proprietor or authorized representative of AMIANAN SECURITY


AND INVESTIGATION AGENCY with office address at #1CAYOSA HOMES,
PENGUE RUYU, TUGUEGARAO CITY, CAGAYAN.

2. As the owner and sole proprietor, or authorized representative of AMIANAN


SECURITY AND INVESTIGATION AGENCY,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 LGU ABULUG,CAGAYAN of
the ABULUG, CAGAYAN ,as shown in the attached duly notarized Special
Power of Attorney;

3. AMIANAN SECURITY AND INVESTIGATION AGENCY 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. AMIANAN SECURITY AND INVESTIGATION AGENCY is authorizing the Head


of the Procuring Entity or its duly authorized representative(s) to verify all the
documents submitted;

6. None of the officers and members of AMIANAN SECURITY AND


INVESTIGATION AGENCY 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. AMIANAN SECURITY AND INVESTIGATION AGENCY complies with existing


labor laws and standards; and

8. AMIANAN SECURITY AND INVESTIGATION AGENCY 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 [Name of the
Project].

9. AMIANAN SECURITY AND INVESTIGATION AGENCY 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.

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 have hereunto set my hand this __ day of ___, 20__ at
____________, Philippines.

DOMINGO EGON Q. CAYOSA

Affiant

[Jurat]

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