Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SOUTHERN LEYTE )
MUNICIPALITY OF TOMAS OPPUS ) S.S.

AFFIDAVIT

I, ROZEL S. SALAN, of legal age, married, Filipino, and residing at Brgy. San Isidro,
Tomas Oppus, Southern Leyte, after having been duly sworn in accordance with
law, hereby depose and state that:

1. I am the sole proprietor of RP Welding Shop with office address at San

Isidro, Tomas Oppus, Southern Leyte;

2. As the owner and sole proprietor of RP Welding Shop, 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 Formulation on Resettlement Action Plan : Site Development: Site
Access and Clearing of Brgy. Biasong Barangay Sub-project Management
Committee.

3. RP Welding Shop 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;

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. RP Welding Shop is authorizing the Barangay Sub-project Management

Committee (BSPMC) Chairperson or its duly authorized representative(s)
the BAC, TWG, PT, KC-NCDDP and/or Funder (ADB/WB etc) to review and
examine the records and accounts related to all the documents
submitted;

6. As owner or sole proprietor of RP Welding Shop, I am not related by

consanguinity or affinity up to the 1st civil degree to the BSPMC
Chairperson or employees of KC-NCDDP Regional Program Management
Office(RPMO) or National Program Management Office(NPMO) who are
having direct access to information that may substantially affect the result
of the bidding, such as, but not limited to, the members of the Bids and
Awards Committee(BAC), the members of the Technical Working Group
(TWG), the Procurement Team (PT), and the designer/s of the Sub-project.

7. RP Welding Shop complies with existing labor laws and standards;

 8. RP Welding Shop is aware of and has undertaken the following
responsibilities as a Bidder:

a. Carefully examine all of the Bidding Documents;

b. Acknowledge all conditions, local or otherwise, affecting the

implementation of the Contract;

c. Made an estimate of the facilities available and needed for the

contract to be bid, if any; and

d. Inquire or secure Supplemental/Bid Bulletin(s) issued for the Formulation

on Resettlement Action Plan : Site Development: Site Access and
Clearing;

9. RP Welding Shop 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.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of April, 2019
at Tomas Oppus, Southern Leyte, Philippines.

_____________________________________
ROZEL S. SALAN
Affiant
VIN: 6418-0044A-L2166RSS10000

SUBSCRIBED AND SWORN to before me 11th day of April, 2019 at Tomas

Oppus, Southern Leyte, Philippines.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019