Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY OF TAGUM ) S.S.

AFFIDAVIT

I, LUDWIG B. RUYERAS, of legal age, Single, Filipino, and residing at

129 – 1st Ave. Misa Dist. , Tagum City, 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 TANCHO

GENERAL MERCHANDISE INC. with office address at 1126
Sobrecary St. Tagum City;

2. I am granted full power and authority to do, execute and perform any
and all acts necessary and/or to represent TANCHO GENERAL
MERCHANDISE INC. in the bidding as shown in the attached
Secretary’s Certificate issued by the corporation;

3. TANCHO GENERAL MERCHANDISE INC. 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. TANCHO GENERAL MERCHANDISE INC. is authorizing the BAC

SECRETARIAT OF BARANGAY TANGLAW, B.E. DUJALI, DAVAO DEL
NORTEor her duly authorized representative/s to verify all the
documents submitted;

6. None of the officers, directors, and controlling stockholders of TANCHO

GENERAL MERCHANDISE INC. is related to the members of the Bids
and Awards Committee (BAC), the Technical Working Group, and the
BAC Secretariat, the Director, Human Resource Development Service
(HRDS), by consanguinity or affinity up to the third civil degree;

7. TANCHO GENERAL MERCHANDISE INC. complies with existing labor

laws and standards; and

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8. TANCHO GENERAL MERCHANDISE INC. 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

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of

October 2016 at Tagum City, Philippines.

_______________________________________
Bidder’s Representative/Authorized Signatory

REPUBLIC OF THE PHILIPPINES)

TAGUM CITY) S.S.

BEFORE ME, a Notary Public for and in the City of Tagum, personally
appeared Ludwig B. Ruyeras exhibiting his Community Tax Certificate No. 02538020 issued
on 01-26-16 in Tagum City and who is known to me and to me known to be the same person
who executed the foregoing Certification and who acknowledged that the same is his free
act and voluntary deed.

WITNESS MY HAND AND NOTARIAL SEAL on this ___ day of ____________,

20__ in Tagum City, Philippines.

Doc. No. ___________;

Page No. ___________;
Book No. ___________;
Series of 20__.