5-Vendors Statement Pursuant to KRS45A.343 Page - FINAL.pdf
PDF 174 KB Posted
- Attached to
- Tamarack Storm Sewer System Evaluation
- Solicitation number
- 4445
- Issued by
- Daviess County, Kentucky
About this file
This document is a Vendor's Statement form from the City of Owensboro, Kentucky, pursuant to Kentucky Revised Statute (KRS) 45A.343. The form requires vendors to disclose and certify compliance with specific Kentucky state statutes related to corporate taxes, sales and use taxes, income taxes, wage and hour regulations, occupational safety, unemployment, and workers' compensation. The document is a standard compliance statement that vendors must complete when entering into a contract with the City of Owensboro.
The form mandates that vendors affirm they have not been finally determined to have violated any of the specified KRS chapters within the past five years and acknowledge their ongoing obligation to comply with these statutes throughout the contract period. Failure to reveal any final determination of violation or to maintain compliance could result in contract cancellation and disqualification from future city contracts for a two-year period. The form provides space for the vendor's company name, authorized representative, signature, and title, to be completed and dated in 2025.
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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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