7-RFB 4492 - Required Affidavits.pdf
PDF 124 KB Posted
- Attached to
- 2026 LARP Street Resurfacing
- Solicitation number
- 4492
- Issued by
- Daviess County, Kentucky
About this file
This document contains required affidavits for bidders, offerors, and contractors on a street resurfacing project in Owensboro, Kentucky. The affidavits are mandatory forms that bidding entities must complete and submit to establish their eligibility and compliance status for the 2026 LARP Street Resurfacing project. The project involves milling and texturing existing street surfaces and resurfacing streets as directed by the City Engineer, utilizing labor, materials, supervision, equipment, and construction staking. The affidavits must be notarized and signed by authorized representatives of the bidding entity.
Bidders must claim and affirm their status under Kentucky law by completing one of two required affidavits. The first affidavit pertains to qualified bidder status under 200 KAR 5:410(3), which includes nonprofit corporations furthering KRS Chapter 163 purposes and qualified nonprofit agencies for individuals with severe disabilities meeting specific employment thresholds and compliance requirements. The second affidavit addresses resident bidder status under KRS 45A.494(2), requiring entities to demonstrate authorization to conduct business in Kentucky, filing of Kentucky income taxes for one year prior to advertisement, current payments to the Kentucky unemployment insurance fund, and maintained workers' compensation policies. The bidding agency reserves the right to request supporting documentation for either claim and may disqualify bidders or terminate contracts for failure to provide requested documentation or false affidavit statements.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING QUALIFIED BIDDER STATUS
FOR BIDS AND CONTRACTS IN GENERAL:
I. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, and all subcontractors therein, meets the requirements to be considered a “qualified bidder” in accordance with 200 KAR 5:410(3); and will continue to comply with such requirements for the duration of any contract awarded. Please identify below the particular “qualified bidder” status claimed by the bidding entity.
________ A nonprofit corporation that furthers the purposes of KRS Chapter 163
_______ Per KRS 45A.465(3), a "Qualified nonprofit agency for individuals with severe disabilities" means an organization that:
(a) Is organized and operated in the interest of individuals with severe disabilities; and
(b) Complies with any applicable occupational health and safety law of the United States and the Commonwealth;
and
(c) In the manufacture or provision of products or services listed or purchased under KRS 45A.470, during the fiscal year employs individuals with severe disabilities for not less than seventy-five percent (75%) of the man hours of direct labor required for the manufacture or provision of the products or services; and
(d) Is registered and in good standing as a nonprofit organization with the Secretary of State.
The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of qualified bidder status.
Failure to provide such documentation upon request may result in disqualification of the bidder or contract termination.
Signature Printed Name
Title Date
Company Name
Address
Subscribed and sworn to before me by (Affiant) (Title) of this _____day of ____________,20___.
(Company Name)
Notary Public
[seal of notary] My commission expires:
http://www.lrc.state.ky.us/kar/200/005/410reg.htm
REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING RESIDENT BIDDER STATUS
FOR BIDS AND CONTRACTS IN GENERAL:
The bidder or offeror hereby swears and affirms under penalty of perjury that, in accordance with KRS 45A.494(2), the entity bidding is an individual, partnership, association, corporation, or other business entity that, on the date the contract is first advertised or announced as available for bidding:
1. Is authorized to transact business in the Commonwealth;
2. Has for one year prior to and through the date of advertisement
a. Filed Kentucky income taxes;
b. Made payments to the Kentucky unemployment insurance fund established in KRS 341.49; and
c. Maintained a Kentucky workers’ compensation policy in effect.
The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of resident bidder status.
Failure to provide such documentation upon request shall result in disqualification of the bidder or contract termination.
Signature Printed Name
Title Date
Company Name
Address
Subscribed and sworn to before me by (Affiant) (Title) of this _____day of ____________,20___.
(Company Name)
Notary Public
[seal of notary] My commission expires:
| organization that: |
| Printed Name: |
| Title: |
| Date: |
| 1: |
| 2: |
| Affiant: |
| Title_2: |
| Company Name: |
| 20: |
| undefined: |
| My commission expires: |
| Printed Name_2: |
| Title_3: |
| Date_2: |
| 1_2: |
| 2_2: |
| Subscribed and sworn to before me by_2: |
| Affiant_2: |
| Title_4: |
| Company Name_2: |
| 20_2: |
| My commission expires_2: |
| A nonprofit corporation that furthers the purposes of KRS Chapter 163: |
| Text1: |
| Text2: |
| Subscribed and sworn to before me by: |
| Text3: |
| Text4: |
File details come from the government source that posted it. Updated .