REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON CITY ) S.S.

AFFIDAVIT OF UNDERTAKING

I, Jane L. Tiu, of legal age, single, Filipino and residing at 18 Gardenia Lane phase 3 The Bellevue
Old Samson Road Balintawak Quezon City 1106, after having been duly sworn in accordance
with law, do hereby deposed and state that:

1. I am duly authorized and designated representative of H2O Plus Water Treatment

Company with office address at Lot 8 Blk 10, 144 Mindanao Avenue H2O Plus Brgy.
Bahay Toro Quezon City 1106;

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 Supply and Delivery of Purified Drinking Water for PRDP-NPCO of the DA -
PHILIPPINE RURAL DEVELOPMENT PROJECT, as shown in the attached Partnership
Resolution;

3. H2O Plus Water Treatment Company is not “blacklisted” or barred from bidding by the
Government of the Philippines or any of its agencies, offices, corporations, or Local
Government Unit, foreign government/ foreign and international financing institution
whose blacklisting rules have been recognized by the Government Procurement Policy
Board;

4. H2O Plus Water Treatment Company is up to date with its filling requirement, has paid
all fees and penalties dues and payable under the provision of the law;

5. H2O Plus Water Treatment Company is in continuous unbroken existence since its
company registration and no action is currently being taken by the SEC to strike the
company off the register or to dissolved it as defunct;

6. As far as the SEC is aware, the company is not in liquidation or subject to an

administration order, no receiver or manager of the company’s property has been
appointed;

7. 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;

8. H2O Plus Water Treatment Company is authorizing the Head of the Procuring Entity or
its duly authorized representative(s) to verify all the documents submitted;

9. H2O Plus Water Treatment Company complies with existing labor laws and standards;
and
 10. H2O Plus Water Treatment Company is aware of the following responsibilities as a
Bidder:

a) Carefully examined all of the Request for Quotation and Technical Specifications;
b) Acknowledge all conditions, local or otherwise, affecting the implementation of the
Purchase Order/Contract;
c) Estimated 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 Supply and Delivery of
Purified Drinking Water for PRDP-NPCO.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of February 2023
at Quezon City Philippines.

Jane L. Tiu
Bidder’s Representative / Authorized Signatory

SUBSCRIBED AND SWORN to before me this ____ day of February 2023 at Quezon City
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 her government-issued Unified Multi-Purpose ID, with her photograph
and signature appearing thereon, with number CRN-0033-4731753-4 and her Community Tax
Certificate No.: _______________ issued on ______________at Quezon City.

Witness my hand and seal this _____ day of February 2023.

Name of the Notary Public

Serial No.: of Commission ___________
Notary Public for _______ until ______
Roll of Attorney No.: _______________
PTR No.: _______(date issued), (place issued)
IBP No.: _______ (date issued), (place issued)

Doc No.:
Page No.:
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Series of 2023