Republic of the Philippines

PROVINCE OF BUKIDNON
Provincial Capitol
Malaybalay City, Bukidnon
Tel. No. 088-221-3114
OMNIBUS SWORN STATEMENT

REPUBLIC OF THE PHILIPPINES )

AFFIDAVIT

I, SHARI D. REYES, of legal age, married, Filipino, and residing at Block 7, Lot 14, Paglaum Village Phase 1,
Casisang, Malaybalay City , after having been duly sworn in accordance with law, do hereby depose and state that:

1. I am the sole proprietor of RYSHA ENTERPRISES with office address Block 7, Lot 14, Paglaum Village Phase I,
Casisang, Malaybalay City;

2. As the owner and sole proprietor of RYSHA ENTERPRISES, I have full power and authority to do, execute and
perform any and all acts necessary to represent it in the bidding “Purchase of Materials for Building
Maintenance”.

3. RYSHA ENTERPRISES 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. RYSHA ENTERPRISES is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to
verify all the documents submitted;

6. I am 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;

7. RYSHA ENTERPRISES complies with existing labor laws and standards; and

8. RYSHA ENTERPRISES is aware of and has undertaken the following responsibilities as a Bidder:

a. a.) Carefully examine all of the Bidding Documents;

b. b.) Acknowledge all conditions, local or otherwise, affecting the implementation of the Contract;

c. 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 bidding “Purchase of Materials for
Building Maintenance”.

9. RYSHA ENTERPRISES 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 5th day of MAY 2020 at MALAYBALAY City,
BUKIDNON, Philippines.

SHARI D. REYES
Bidder’s Representative/Authorized Signatory

SUBSCRIBED AND SWORN TO before me this 5th day of MAY 2020 affiant exhibiting to me her PRC No.
108714 issued on January 23, 2017 at MALAYBALAY City, BUKIDNON, Philippines.

.
NOTARY PUBLIC

Doc. No. ________;

BID-SECURING DECLARATION

Invitation to Bid/Request for Expression of Interest No. 1: Purchase of Materials for Building Maintenance

To: LGU MANOLO FORTICH, BUKIDNON

I, SHARI D. REYES, the undersigned, declare that:

1. I 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 accept that: (a) I will be automatically disqualified from bidding for any contract with any procuring entity
for a period of two (2) years upon receipt of your Blacklisting Order; and, (b) I will pay the applicable fine
provided under Section 6 of the Guidelines on the Use of Bid Securing Declaration, if I have committed any of
the following actions:

(i.) Withdrawn my Bid during the period of bid validity required in the Bidding Documents; or

(ii.) Fail or refuse to accept the award and enter into contract or perform any and all acts necessary
to the execution of the Contract, in accordance with the Bidding Documents after having been
notified of your acceptance of our Bid during the period of bid validity.

3. I 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 declared ineligible or post-disqualified upon receipt of your notice to such effect, and (i.)
I failed to timely file a request for reconsideration or (ii.) I filed a waiver to avail of said right;

(c.) I am declared as the bidder with the Lowest Calculated and Responsive Bid/Highest Rated and
Responsive Bid, and I have furnished the performance security and signed the Contract.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of APRIL 2020 at MALAYBALAY City, BUKIDNON,
Philippines.

SHARI D. REYES
Authorized Managing Officer
Affiant

 
SUBSCRIBED AND SWORN to before me this 5th day of APRIL 2020 at MALAYBALAY City, BUKIDNON, Philippines.
Affiant is personally known to me and was identified by me through competent evidence of identity as defined in the 2004
Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant exhibited to me his Professional Regulation Commission I.D., with
his photograph and signature appearing thereon, with no. 0108714 at MALAYBALAY City, BUKIDNON, Philippines.

NOTARY PUBLIC
Serial No. of Commission______
Notary Public for ______ until _____
Roll of Attorneys No. _____
PTR No. _____
IBP No. _____

Doc. No. ________;