BARANGAY CUPANG Project Reference

Number______________________

Name of the Project_________________________

Location of the Project_______________________

Standard Form Number: SF-CONS-14

Revised on: 9 May 04
Standard Form Title: Certification of Non-inclusion in the Blacklist

October 16, 2018

PB. EDWIND F. AVILLA

Punong Barangay
Barangay CUAPANG

Attention : The Chairman

Bids and Awards Committee

Dear Sir / Madame:

In compliance with the requirements of Barangay Cupang BAC and pursuant to the Implementing
Rules and Regulations of Republic Act 9184, the undersigned hereby declares that
RITCHIELAYNE MERCHANDISE intending to bid PROCUREMENT OF FRUIT
BEARING TREES for this project is not included in the blacklist of consultants for government
or any of its agencies, offices, corporations, or local government units; neither is it included in the
Consolidated Blacklisting Report issued by the Government Procurement Policy Board.

Very truly yours,

RITCHIEL C. MIRASOL
Proprietor
RITCHIELAYNE MERCHANDISE

One of the legal documents required to be in the Eligibility Envelope of a prospective bidder is its
Statement that it is not “blacklisted” or barred from bidding by the Government or any of its agencies,
offices, corporations or LGUs, including non-inclusion in the Consolidated Blacklisting Report issued by the
GPPB (once it does so).