_2023- Annual Required Affidavit for Bidders Offerors and Contractors (4).pdf

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Attached to
KYPCIS Catering / Bowling Green KY
Solicitation number
RFQ 525 2700000003 1
Issued by
Johnson County, Kentucky

About this file

This is a Required Affidavit for Bidders, Offerors and Contractors form issued by the Commonwealth of Kentucky pursuant to KRS 45A.110 and KRS 45A.115. The affidavit is required for any bidder, offeror, or contractor seeking to be awarded a contract or to renew an existing contract with the state of Kentucky. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The affidavit is effective for one year from the date of execution and may be requested for renewal at any time at the Commonwealth's discretion.

The attestation requires the authorized representative to swear and affirm under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that the award of the contract will not violate any provision of those laws. For purposes of this attestation, "knowingly" is defined to include violations of which the bidder or offeror is aware or should have been aware. The form requires completion of contractor information including name, address, and Commonwealth Vendor Code if known, along with notarization by a qualified notary public with the notary's commission expiration date.

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Text version

Rev. 9-16-22

Required Affidavit for Bidders, Offerors and Contractors

(KRS 45A.110 & 45A.115)

Affidavit Effective for One (1) Year from Date of Execution

Instructions: Pursuant to KRS 45A.110 and 45A.115, a bidder, offeror, or contractor

(“Contractor”) is required to submit a Required Affidavit for Bidders, Offerors, and Contractors to be awarded a contract, or for the renewal of a contract. An authorized representative of the contracting party must complete the attestation below, have the attestation notarized, and return the completed affidavit to the Commonwealth.

Attestation

As a duly authorized representative for the Contractor, I swear and affirm under penalty of perjury, that that the Contractor has not knowingly violated campaign finance laws of the Commonwealth of Kentucky and that the award of a contract will not violate any provision of the campaign finance laws of the Commonwealth. For purposes of this attestation, "Knowingly" means that the bidder or offeror is aware or should have been aware of the existence of a violation. The bidder or offer understands that the Commonwealth retains the right to request an updated affidavit at any time.

Signature Printed Name

Title Date

Bidder or Offeror Name: __________________________________________________________

Address: __________________________________________________________

Commonwealth of Kentucky Vendor Code (If known): _______________

Subscribed and sworn to before me this _____ day of _______________, ____________.

State of: ___________________ Notary: ___________________________________

County of: _________________ My Commission Expires: _____________________ https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22348 https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22349

Date:
Signature:
Title:
Printed Name:
Bidder or Offeror Name:
Address Line 1:
Address Line 2:
Address Line 3:
Vendor Code:
Day:
Month:
Year:
State:
Notary Name:
County Name:
Commission Expiration Date:

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