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

PDF 253 KB Posted

Attached to
DOCJT Spring Tree Trimming
Solicitation number
RFQ-525-2400000046-1
Issued by
Madison County, Kentucky

About this file

This document is a required affidavit for bidders, offerors, and contractors to be awarded a contract or for the renewal of a contract with the Commonwealth of Kentucky. The affidavit attests that the contractor has not knowingly violated the 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. The affidavit must be completed by an authorized representative of the contracting party, notarized, and returned to the Commonwealth.

The related state and local contract opportunity is for DOCJT Spring Tree Trimming, which is located in Madison County, Kentucky. No other details about the project, such as quantities, response dates, or contract terms, are provided in the given information.

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Final_RFQ_525_2400000046_1_SO_FORM.PDF PDF

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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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