Omnibus Sworn Statement Bataan Gen With Signature

Omnibus Sworn Statement (Revised)
[shall be submitted with the Bid]

_________________________________________________________________________
REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.
AFFIDAVIT
I, JO-ANNE T. HASAL, of legal age, Married, Pilipino, and residing at Blk 1 Lot 37 & 38
Gardenia St., Summerfield East Brgy San Juan Taytay Rizal after having been duly sworn in
accordance with law, do hereby depose and state that:
1. I am the duly authorized and designated representative of Biologic Life Sciences

Corp with office address at Unit 2B 24th Place Stella Maris St., Brgy Maybunga Pasig
City;
2. I am granted 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 Small Value Procurement for COVID ANTIGEN TEST of Bataan
General Hospital and Medical Center, as shown in the attached Notarized
Secretary’s Certificate;
3. Biologic Life Sciences Corp 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. Biologic Life Sciences Corp 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 Biologic Life Sciences Corp 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. Biologic Life Sciences Corp complies with existing labor laws and standards; and
8. Biologic Life Sciences is aware of and has undertaken the responsibilities as

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 Small Value
Procurement for COVID Antigen Test;
9. Biologic Life Sciences Corp 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.
Jo-Anne T. Hasal
General Manager
Affiant
SUBSCRIBE AND SWORN to before me this ___________________, at Pasig City, 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 Pracice (A.M.
No. 02-8-13-SC). Affiant/s exhibited to me her Driver’s License, with her photograph
and signature appearing thereon, with no. D16-91050245 on July 2022 issued at LTO
Robinsons Metro East, Philippines.
NAME OF NOTARY PUBLIC

Serial No. of Commission ____________
Notary Public for until _______________
Roll of Attorney’s No. _______________
PTR No. ______[date issued], [place issued]
IBP No. _______[date issued], [place issued]
Doc. No.:_____
Page No.:_____
Book No.:_____
Series of 2024

Omnibus Sworn Statement Bataan Gen With Signature

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Omnibus Sworn Statement (Revised)

[shall be submitted with the Bid]

REPUBLIC OF THE PHILIPPINES )

1. I am the duly authorized and designated representative of Biologic Life Sciences

4. Each of the documents submitted in satisfaction of the bidding requirements is an

8. Biologic Life Sciences is aware of and has undertaken the responsibilities as

a. Carefully examining all of the Bidding Documents;

SUBSCRIBE AND SWORN to before me this ___________________, at Pasig City, Philippines.

NAME OF NOTARY PUBLIC

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