REPUBLIC OF THE PHILIPPINES )
_______________________________ ) S.S.
AFFIDAVIT
I, Kelsey de Alvia Ortiz of legal age, Married, Filipino, and residing at 340 Tuazon St.
Tondo Manila, 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 Kelmed Trading with office
address at 340 Tuazon St. Tondo Manila;
2. I have full power and authority to do, execute and perform any and all acts necessary
to represent it in the Small Value Procurements of the Department of Foreign Affairs
for the C.Y. 2018;
3. I am granted full power and authority to do, execute and perform any and all acts
necessary and/or to represent the Kelmed Trading being a sole proprietorship.
4. Kelmed Trading 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;
5. Each of the documents submitted in satisfaction of the requirements for Small Value
Procurement is an authentic copy of the original, complete, and all statements and
information provided therein are true and correct;
6. Kelmed Trading is authorizing the Head of the Procuring Entity or its duly authorized
representative(s) to verify all the documents submitted;
7. None of the officers, directors, and controlling stockholders of Kelmed Trading 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;
8. Kelmed Trading complies with existing labor laws and standards; and
9. Kelmed Trading is aware of and has undertaken the following responsibilities:
a) Acknowledge all conditions, local or otherwise, affecting the implementation of
the Contract;
b) Made an estimate of the facilities available and needed for the contract, if any;
10. Kelmed Trading 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.
11. Kelmed Trading can be reached through contact number 0917 5802453.
IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of October, 2020 at
Quezon City, Philippines.
_____________________________________
Authorized Representative/Authorized Signatory
SUBSCRIBED AND SWORN to before me this 29th day of October, 2020 at
Quezon City, Philippines. Affiant/s is/are personally known to me and was/were 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/s exhibited to me his/her [insert type of government
identification card used], with his/her photograph and signature appearing thereon, with no.
______ issued on ______ at ______.
(Notary Public)
Doc. No._____;
Page No._____;
Book No._____;
Series of _____;
