Omnibus Sworn Statement (Revised)

[shall be submitted with the Bid]

_________________________________________________________________________

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

AFFIDAVIT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of
Affiant], after having been duly sworn in accordance with law, do hereby depose and state
that:

1. [Select one, delete the other:]

[If a sole proprietorship:] I am the sole proprietor or authorized representative of [Name of

Bidder] with office address at [address of Bidder];

[If a partnership, corporation, cooperative, or joint venture:] I am the duly authorized and
designated representative of [Name of Bidder] with office address at [address of Bidder];

2. [Select one, delete the other:]

[If a sole proprietorship:] As the owner and sole proprietor, or authorized representative of
[Name of Bidder], 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 [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached
duly notarized Special Power of Attorney;

[If a partnership, corporation, cooperative, or joint venture:] 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 [Name of the Project] of the [Name
of the Procuring Entity], as shown in the attached [state title of attached document showing
proof of authorization (e.g., duly notarized Secretary’s Certificate, Board/Partnership
Resolution, or Special Power of Attorney, whichever is applicable;)];

3. [Name of Bidder] 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. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized
representative(s) to verify all the documents submitted;

6. [Select one, delete the rest:]

[If a sole proprietorship:] 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;

[If a partnership or cooperative:] None of the officers and members of [Name of Bidder] 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;

[If a corporation or joint venture:] None of the officers, directors, and controlling
stockholders of [Name of Bidder] 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. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] 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. [Name of Bidder] 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.

[Insert NAME OF BIDDER OR ITS AUTHORIZED

REPRESENTATIVE]
[Insert signatory’s legal capacity]
Affiant

[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]
 Bid Securing Declaration Form
[shall be submitted with the Bid if bidder opts to provide this form of bid security]
_________________________________________________________________________

REPUBLIC OF THE PHILIPPINES)

CITY OF _______________________) S.S.

BID SECURING DECLARATION

Project Identification No.: [Insert number]

To: [Insert name and address of the Procuring Entity]

I/We, the undersigned, declare that:

1. I/We understand that, according to your conditions, bids must be supported by a Bid
Security, which may be in the form of a Bid Securing Declaration.

2. I/We accept that: (a) I/we will be automatically disqualified from bidding for any
procurement contract with any procuring entity for a period of two (2) years upon receipt
of your Blacklisting Order; and, (b) I/we will pay the applicable fine provided under
Section 6 of the Guidelines on the Use of Bid Securing Declaration, within fifteen (15)
days from receipt of the written demand by the procuring entity for the commission of
acts resulting to the enforcement of the bid securing declaration under Sections 23.1(b),
34.2, 40.1 and 69.1, except 69.1(f),of the IRR of RA No. 9184; without prejudice to other
legal action the government may undertake.

3. I/We understand that this Bid Securing Declaration shall cease to be valid on the
following circumstances:

a. Upon expiration of the bid validity period, or any extension thereof pursuant to your
request;
b. I am/we are declared ineligible or post-disqualified upon receipt of your notice to such
effect, and (i) I/we failed to timely file a request for reconsideration or (ii) I/we filed a
waiver to avail of said right; and
c. I am/we are declared the bidder with the Lowest Calculated Responsive Bid, and
I/we have furnished the performance security and signed the Contract.

IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ____ day of [month]
[year] at [place of execution].

[Insert NAME OF BIDDER OR ITS AUTHORIZED

REPRESENTATIVE]
[Insert signatory’s legal capacity]
Affiant

[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]
 APPENDIX “1”

Bid Form for the Procurement of Goods

[shall be submitted with the Bid]
_________________________________________________________________________

BID FORM
Date : _________________
Project Identification No. : _________________

To: [name and address of Procuring Entity]

Having examined the Philippine Bidding Documents (PBDs) including the

Supplemental or Bid Bulletin Numbers [insert numbers], the receipt of which is hereby duly
acknowledged, we, the undersigned, offer to [supply/deliver/perform] [description of the
Goods] in conformity with the said PBDs for the sum of [total Bid amount in words and
figures] or the total calculated bid price, as evaluated and corrected for computational errors,
and other bid modifications in accordance with the Price Schedules attached herewith and
made part of this Bid. The total bid price includes the cost of all taxes, such as, but not
limited to: [specify the applicable taxes, e.g. (i) value added tax (VAT), (ii) income tax, (iii)
local taxes, and (iv) other fiscal levies and duties], which are itemized herein or in the Price
Schedules,

If our Bid is accepted, we undertake:

a. to deliver the goods in accordance with the delivery schedule specified in the
Schedule of Requirements of the Philippine Bidding Documents (PBDs);

b. to provide a performance security in the form, amounts, and within the times
prescribed in the PBDs;

c. to abide by the Bid Validity Period specified in the PBDs and it shall remain binding
upon us at any time before the expiration of that period.

[Insert this paragraph if Foreign-Assisted Project with the Development Partner:

Commissions or gratuities, if any, paid or to be paid by us to agents relating to this
Bid, and to contract execution if we are awarded the contract, are listed below:

Name and address Amount and Purpose of

of agentCurrencyCommission or gratuity

________________________________________________
________________________________________________
________________________________________________
(if none, state “None”) ]

Until a formal Contract is prepared and executed, this Bid, together with your written
acceptance thereof and your Notice of Award, shall be binding upon us.

We understand that you are not bound to accept the Lowest Calculated Bid or any
Bid you may receive.

We certify/confirm that we comply with the eligibility requirements pursuant to the

PBDs.
 The undersigned is authorized to submit the bid on behalf of [name of the bidder] as
evidenced by the attached [state the written authority].

We acknowledge that failure to sign each and every page of this Bid Form, including the
attached Schedule of Prices, shall be a ground for the rejection of our bid.

Name: ___________________________________________________________________
Legal capacity: _____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Date: ___________________
 Price Schedule for Goods Offered from Within the Philippines
[shall be submitted with the Bid if bidder is offering goods from within the Philippines]
______________________________________________________________________________

For Goods Offered from Within the Philippines

Name of Bidder ________________________ Project ID No._________ Page ___of___

1 2 3 4 5 6 7 8 9 10

Item Description Country Quantity Unit Transportation Sales and Cost of Total Total Price
of origin price and all other other Incidental Price, delivered
EXW costs taxes Services, if per unit Final
per incidental to payable if applicable, Destination
item delivery, per Contract per item (col
item is 5+6+7+ (col 9) x
awarded, 8) (col 4)
per item

Name: ___________________________________________________________________

Legal Capacity: ____________________________________________________________

Signature: ________________________________________________________________

Duly authorized to sign the Bid for and behalf of: __________________________________
Name of the Procuring Entity : Tourism Promotions Board
Project :
Location of the Project :

List of all Ongoing Government & Private Contracts including contracts awarded but not yet started

Business Name :
Business Address :

Bidder’s Role % of Value of

a. Owner’s Name a. Date Awarded Accomplishment Outstanding
Name of Contract/ Project Cost b. Address Nature of Work b. Date Started Planned Actual Works /
c. Telephone Nos. Description % c. Date of Completion Undelivered
Portion
Government

Private

Total Cost
Note: This statement shall be supported with:
1. Notice of Award and/or Contract
2. Notice to Proceed
3. Certificate of Accomplishment signed by the authorized representative

Submitted by :
(Printed Name & Signature)
Designation : __________________________________________________

Date : ___________________________________________________
Name of the Procuring Entity : Tourism Promotions Board
Project :

Location of the Project :

Statement of Single Largest Completed Contract (SLCC) similar to the Contract to be
bid within five (5) years, contract should be atleast be fifty percent (50%) of the ABC
Business Name :
Business Address :

a. Owner’s Name Bidder’s Role a. Amount of Award a. Date Awarded

Name of b. Owner’s Name Address Nature of b. Amount at Completion b. Contract Effectivity
Contract c. Telephone Nos. Work Description % c. Duration c. Date Completed

Government

Private

Note: This Statement shall be supported with

1. Contract
2. Certificate with completion

Submitted by:

Name of Representative of Bidder: _______________________________

Position : _______________________________
Date : _______________________________