7-RFB 4495 - Required Affidavits.pdf

124 KB Posted

Attached to
Fence Replacement at Fisher Park
Solicitation number
4495
Issued by
Clinton County, Kentucky

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Written by GovTribe AI ·

This document contains required affidavits for bidders, offerors, and contractors seeking to claim qualified bidder or resident bidder status in accordance with Kentucky Administrative Regulations and Kentucky Revised Statutes, applicable to the City of Owensboro's fence replacement project at Fisher Park. The affidavits establish two distinct qualification pathways: qualified bidder status under 200 KAR 5:410(3), which includes nonprofit corporations furthering KRS Chapter 163 and qualified nonprofit agencies for individuals with severe disabilities meeting specific employment thresholds; and resident bidder status under KRS 45A.494(2), which requires bidders to be authorized to transact business in Kentucky with demonstrated tax filing, unemployment insurance fund payments, and active workers' compensation coverage for the year preceding contract advertisement. Bidders must execute the applicable affidavit under penalty of perjury and have it notarized, with signature, printed name, title, date, and company information clearly documented.

The bidding agency reserves the right to request supporting documentation for any claimed qualified or resident bidder status and may disqualify bidders or terminate contracts for failure to provide requested documentation. For entities claiming qualified nonprofit agency status, the affidavit requires documentation that the organization is registered and in good standing with the Secretary of State and demonstrates that individuals with severe disabilities comprise at least seventy-five percent of direct labor hours for products or services manufactured or provided. All affidavits must be subscribed and sworn before a notary public with commission expiration date noted.

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Other files

File Type Posted
4-Standard General Conditions.pdf PDF
6-Fisher Park Fencing Sketch.pdf PDF
3-Sample Payment Bond Form - FINAL.pdf PDF
1-Sample Bid Bond Form - FINAL.pdf PDF
5-Sample Agreement Between Owner and Contractor - FINAL.pdf PDF
2-Sample Performance Bond Form - FINAL.pdf PDF

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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:

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