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A ffi d a v i t E ff e c ti v e D a t e : A ffi d a v i t E x pi r a t i on D a te : Ma x im u m L en g t h O n e - Y ear RE Q U IR E D A F F ID A V I T FOR B ID D ER S , O F F E R O R S AN D C O NTRA C T O R S P AG E 1 O F 2 FOR B IDS AN D C O NTRACT S IN GENER AL : I . Each b i dd e r or o f f e r or s w e a r s a n d a f f i r m s und e r p en a l t y of pe r j u r y , t h a t t o t h e b e st of t h e i r k no w l ed g e : a. I n acco r dan c e wi t h HYPERLINK "http://www.lrc.state.ky.us/KRS/045A00/110.PDF" \h K R S 4 5 A .110 and K R S 45 A .11 5 , ne i t h e r t he b i dd e r o r o ff e r or as d e fi n ed i n K R S 45 A .070 ( 6 ) , n o r t he en t it y w h i ch he / she r e p r e s e n t s, has k no w i n g l y v i o l a t ed any p r o v i s i o ns o f t he ca m pa i g n fi n ance l aws o f t he C o m m on w ea lt h of K e n t uc ky ; and t he aw a r d o f a c on t r act t o t he b i d d er or o ff e r o r or t he e n t i t y w h i ch he / s h e r e p r e s e n t s wi l l n ot v i o l a t e any p r o v i s i ons o f t h e ca m pa i g n fi nan c e l aws of t h e Co m m on w ea lt h. b. T he b i dd e r or o f f e r or swe ar s a n d a f f ir m s un d er pe n a l t y of p e r j u r y t h a t , t o t he e x t e nt r e qu i r ed by K en t uc k y l aw, t he e n t i t y b i d d i n g , a nd a l l sub c on t r a c t o r s t h e r e i n, a r e aw a r e o f t he r equ i r e m en t s and p en a l t i es ou t l i n e d i n K R S 45 A . 4 8 5 ; ha v e p r o pe r l y d i s c l o s e d a l l i n f o r m a ti o n r eq u ir e d by t h i s s t a t u t e ; a n d wil l con t i nue t o co m p l y w it h s u ch r e qu i r e m en t s f or t he du r a t i on of any con t r a c t a w a r d ed. c. T he b i dd e r or o f f e r or swe ar s a n d a f f ir m s un d er pe n a l t y o f p e r j u r y t h a t , t o t he e x t e nt r e qu i r ed by K en t uc k y l aw, t he en t it y b i dd i n g , a n d i t s a f f i l i a t e s , a r e d u l y r e g i s t e r ed wi t h t he K en t uc k y D epa r t m ent of R e v enue t o c o l l e c t a nd r e m i t t he s a l es a n d u s e t ax i m pos e d by HYPERLINK "http://www.lrc.ky.gov/KRS/139-00/CHAPTER.HTM" \h K R S C ha p t e r 1 3 9 , a nd wi l l r e m a i n r e g i s t e r ed f o r t he d u r a ti o n of any con t r a c t award e d. d. T he b i dd e r or o f f e r or swe ar s and a f f ir m s un d er pe n a l t y of p e r j u r y t h a t t he e n t i t y b i d d i ng i s n o t d e l i nq u e n t on any s t a t e t ax e s or f ees o w ed t o t he Co mm on w ea lt h of K e n t u c k y and wi l l r e m a i n i n g ood s t an d i ng f o r t he d u r a ti o n of any con t r a c t award e d. e. The bidder o r of f e ror sw ea rs a nd a f fi r ms under pe na l t y of pe r j u r y that the e nt i t y bidd i n g , is not c ur re nt l y e n g a g e d in, a n d will not for the d u r a t i o n of the c ont r ac t e n g a ge in, the b o y c ott of a p e rson or a n e nt i t y b a s e d in or doing busin e ss with a jurisd i c t i on with whi c h K e ntuc k y ca n e nj o y op e n tr a d e , a s d e fin e d in KRS 45A.607. f . T he b i d der o r o ff e r or swe ar s and a f f ir m s t h a t t he e n t i t y b i d d i n g , and a l l s ubco n t r a c t o r s t h e r e i n, h a v e not v i o l a t ed any of t he p r o h i b i ti ons s e t f o r t h i n K R S 11 A . 2 36 du r i ng t he p r e v i o u s t en ( 10) y ea r s , and f u rt h er p l ed g e t o a b i de by t he r e s t r i c t i ons s et f o r t h i n s u ch s t a t u t e f or t he du r a t i on o f t h e c on t r act awa r ded. FOR “ N O N - B ID” C O N T RACT S ( I.E. S O LE - SO U RCE ; N O T - P RACT IC A L O R F EA S I B L E T O B I D ; O R E ME R GENC Y C O NTRACT S, ETC ) : II . Each c o n t r a c t or f u r t h e r sw e a r s a nd a f f ir m s und e r pe n a l t y of pe r j u r y , t hat t o t he be s t of t h e i r k no wl ed g e : a. I n acco r da n c e w it h K R S 1 2 1.05 6 , and i f t h i s i s a no n - b i d co n t r ac t , n e i t her t h e con t r ac t o r , n or any m e m ber of h i s / h e r i mm ed i a t e f a m i l y ha v i n g an i n t e r e s t of 1 0 % or m o r e i n any bus i n e s s en t i t y i n v o l v ed i n t h e pe r f o r m ance of any con t r a c t awa r ded, h a v e con t ri b u t ed m o r e t han t h e a m ount sp ec i f i ed i n K R S 1 21.1 5 0 t o t he ca m pa i g n of t he g ub e r n a t o r i al s l a t e e l e c t ed i n t h e e l e c t i on l a s t p r e c ed i ng t he d a t e of con t r a ct award. RE Q U IR E D A F F ID A V I T FOR B ID D ER S, O F F E R O R S AN D C O NTRA C T O R S P AG E 2 O F 2 b. I n acco r dan c e wi t h K R S 1 2 1.330 ( 1 ) a nd ( 2 ) , and i f t h i s i s a n o n - b i d con t r a c t , n e it h er t he co n tr a c t o r , n or o f f i c e r s or e m p l o y ees o f t h e co n t r a c t or or any e n t it y a f f i l i a t ed wi t h t he co n t r a c t o r , n or t h e s pou s es of o f f i c e r s or e m p l o y ees of t he c o n t r a c t or or any e n t i t y a f f i l i a t e d w it h t h e c on t r a c t o r , ha v e k no w i n g l y con t ri b u te d m o r e t han $5 ,0 00 i n a gg r e g a t e t o t he c a m pa i g n of a c and i da t e e l e c t e d i n t h e e l e c ti on l a s t p r e c e di ng t h e d a t e o f c o n t r a ct aw a r d t h a t has j u r i sd i c t i o n o v er t h i s c on t r a c t aw a r d. c. I n acco r dan c e wi t h K R S 1 21.330 ( 3) a nd ( 4 ) , and i f t h i s i s a no n - b i d co n tr a c t , t o t he be s t o f h i s / h er k no w l ed g e, ne i t her t h e co n tr a c t o r , n o r any m e m ber of h i s / h e r i mm ed i a t e f a m il y , h i s / h e r e m p l o y e r , or h i s / her e m p l o y ees, or any e n t i t y a f f i l i a t ed wi t h any of t he s e e n t it i es o r i n d i v i du a l s, ha v e d ir e c t l y so l i c i t ed con t ri b u t i ons i n e x ce s s of $ 30,000 i n t h e a gg r e g a t e f or t he c a m pa i g n of a can d i d a t e e l e c t ed i n t he e l e c t i o n l a s t p r ec e d i ng t he d a t e o f c on t r act awa r d t h at h as j u r i s d i c ti on o v er t h i s con t r a c t . A s a du l y au t h o ri z ed r e p r es en t a ti v e f o r t he b i d d e r , o ff e r o r , o r co n tr a c t o r , I h a v e f u l l y i n f o r m ed m y s el f r e g a r d i n g t he acc u r acy of a l l s t a t e m en t s m ade i n t h i s a f f i da v i t , and ac k no w l ed g e t h at t h e C o mm on w ea lt h i s r e a son a b l y r e l y i ng upon t he s e s t a t e m en t s, i n m a k i ng a dec i s i on f o r c on t r act aw a r d a n d any f a i l u r e t o ac c u r a t e l y d i s c l o s e su c h i n f o r m a ti on m ay r e s u l t i n c on t r act t e r m i n a ti o n , r epa y m ent of f un d s and o t h er a v a i l ab l e r e m ed i es un d er l aw. I f t h e b i dd e r , o f f e r o r , o r con t r a c t or beco m es no n - c o m p li a n t w it h any s t a t e m en t s d u ri ng t he a f fi d a v i t e f f e c t i v e pe r i od, I w il l n o t i f y t h e F i na n ce and A d m i n i s t r a t i on Cab i n e t , O f fi c e o f P r oc u r e m ent Se r v i ce s i mm ed i a t e l y . I und e r s t and t h at t he Co m m on w ea lt h r e t a i ns t he ri g ht t o r equ e st a n up da t ed a f f i da v i t at any ti m e. Si g na t u r e Pr i n t ed Na m e Ti t l e D a t e C o m pany N a m e A dd r e s s C o m m on w ea lt h of K e n t uc k y V endor C o de ( i f k no w n) Subsc r i b e d and sworn t o be f o r e m e by ( A f f i a n t ) ( T i tl e ) of t h i s ( C o m pany N a m e) _day of ,20 _ . N o t a r y Pub l i c [ s e a l o f n o t a r y ] My co m m i s si on ex p i r e s : ANNUAL A FF ID A V IT FOR B ID D ER S , O F F EROR S AN D C O NTRACT O R S 2020-08-14T00:00:00Z 2021-07-16T00:00:00Z %USERNAME% Dianne Lee 2 2021-07-16T15:52:00Z 2021-07-16T15:52:00Z Normal 1 2 867 4944 Microsoft Office Word 0 41 11 false Title 1 Commonwealth of Kentucky false 5800 false false 16.0000