4-Vendors Statement Pursuant to KRS45A.343 Page - FINAL.pdf
PDF 174 KB Posted
- Attached to
- Ben Hawes Pickleball Complex
- Solicitation number
- 4444
- Issued by
- Cumberland County, Kentucky
About this file
This document is a vendor compliance statement form required by the City of Owensboro, Kentucky, pursuant to Kentucky Revised Statute (KRS) 45A.343. The form serves as a mandatory disclosure and compliance certification that vendors must complete when contracting with the City of Owensboro, covering various state tax and labor law requirements including corporate taxes (KRS 136), sales and use taxes (KRS 139), income taxes (KRS 141), wage and hour laws (KRS 337), occupational safety (KRS 338), unemployment compensation (KRS 341), and workers' compensation (KRS 342). The document is dated for 2025 and includes blank signature fields for company authorization.
The form requires vendors to certify they have not violated any of the specified Kentucky statutes within the five-year period preceding the statement and acknowledge ongoing compliance requirements throughout the contract duration. Non-disclosure of violations or non-compliance can result in contract cancellation and a two-year disqualification from future City of Owensboro contracts. The document includes contact information for the City of Owensboro Purchasing Department at 270-687-8431, located at 101 E. 4th Street, P.O. Box 10003, Owensboro, KY 42302-9003.
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Text version
VENDOR’S STATEMENT PURSUANT TO KRS45A.343
45A.343 Local Public Agency may adopt provisions of KRS 45A.345 to 45A.460— Effect of adoption – Contracts required to mandate revealing of violations of and compliance with specified KRS chapters – Effect of nondisclosure or noncompliance.
(KRS 136 – Corporate taxes; KRS 139 – Sales & use taxes; KRS 141 – Income taxes;
KRS 337 – Wage and hour; KRS 338 – Occupational safety; KRS 341 – Unemployment;
KRS 342 – Workers Comp.)
The undersigned, as a duly authorized officer of ______________________________________ pursuant to KRS45A.343 states;
1. To the best of my knowledge, information and belief, ____________________________ has not been finally determined to have violated any of the provisions of KRS Chapters
136, 139, 141, 337, 338, 341, or 342 that apply to it within the five year period preceding this statement.
2. __________________________________________ acknowledges that it will be required to be in compliance with those provisions of KRS Chapters 136, 139, 141, 337, 338, 341, and 342 that apply to it for the duration of the Contract to be entered into with the City of Owensboro, Kentucky.
3. __________________________________________ acknowledges that if it fails to reveal any final determination of violation of KRS Chapters 136, 139, 141, 337, 338, 341, or 342, or to comply with the applicable provisions of those statutes for the duration of the aforesaid Contract, such shall be grounds for The City of Owensboro, Kentucky to:
a. Cancel its contract with___________________________________________, and
b. Disqualify _______________________________________________from eligibility for future contracts awarded by The City of Owensboro for a period of two years.
This _______ day of _____________________, 2025.
Company Name: ________________________________________________
By: ___________________________________________________________
Signature: _____________________________________________________
Title: ________________________________________________________
| The undersigned as a duly authorized officer of: |
| To the best of my knowledge information and belief: |
| 2: |
| 3: |
| Cancel its contract with: |
| Disqualify: |
| This: |
| day of: |
| Company Name: |
| By: |
| Title: |
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