AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Electric Motors for Transit Buses State and local contract opportunity
- Solicitation number
- 2024-08
- Issued by
- Fayette County, Kentucky
About this file
The document is an Affidavit of Compliance for Disadvantaged Business Enterprise (DBE) from Lextran, designed to be completed by proposers or subcontractors who qualify as a Disadvantaged Business Enterprise. The form requires the authorized representative of a company to declare and affirm their status as a DBE as defined by specifications, and commit to providing additional documentation if requested by Lextran.
The affidavit is a formal legal document that requires the company representative to solemnly declare under penalties of perjury that the information provided is true and correct. The form includes spaces for the state and county, company details, an authorized signature, printed name, and requires notarization, including the notary's name, signature, and commission expiration date. While the document itself does not contain specific contract details, it is a standard compliance form used in government contracting to verify and document the status of disadvantaged business enterprises seeking to participate in procurement opportunities.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Electric_Motors_for_Transit_Buses.pdf | ||
| FINANCIAL_CAPACITY_FORM.pdf | ||
| BUY_AMERICA_FORM_-_BUSES_&_ROLLING_STOCK_ASSOCIATED_EQUIPMENT.pdf | ||
| CERTIFICATE_OF_PROCUREMENT_INTEGRITY.pdf | ||
| NON-COLLUSION_AFFIDAVIT.pdf | ||
| CERTIFICATION_OF_CONTRACTOR_REGARDING_DEBARMENT,_SUSPENSION,_AND_OTHER_INELIGIBILITY_AND_VOLUNTARY_EXCLUSION.pdf | ||
| CERTIFICATION_OF_RESTRICTIONS_ON_LOBBYING.pdf |
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Text version
AFFIDAVIT OF COMPLIANCE - DISADVANTAGED BUSINESS ENTERPRISE
To be filled out only by proposers that are Disadvantaged Business Enterprise (DBE) or subcontractors who are DBE.
State of ____________________________
County of __________________________
I hereby declare and affirm, that I am the _____________________________________________ (Title)
And duly authorized representative of ________________________________________________ (Company Name)
Company address: ___________________________________________________________________
I hereby declare and affirm that I am a Disadvantaged Business Enterprise (DBE) as defined by the specifications and that I will provide information requested by Lextran to document this fact.
I do solemnly declare and affirm, under the penalties of perjury, that the contents of the aforementioned document are true and correct and that I am authorized, on behalf of the above firm, to execute this affidavit.
DATE: ___________________________________________________________
AUTHORIZED SIGNATURE: _______________________________________
PRINT NAME: ___________________________________________________
Sworn to before me and subscribed in the presence this ______ day of __________________, 20_____.
Notary Public Name: ______________________________________________________
Notary Public Signature: ___________________________________________________
My Commission Expires: ____________________________________
| Company address: |
| I hereby declare and affirm that I am the: |
| And duly authorized representative of: |
| undefined: |
| PRINT NAME: |
| Sworn to before me and subscribed in the presence this: |
| day of: |
| 20: |
| Notary Public Name: |
| Signature1_es_:signer:signature: |
| Signature2_es_:signer:signature: |
| Text3: |
| Text4: |
| Date5_es_:signer:date: |
| Date6_es_:signer:date: |
File details come from the government source that posted it. Updated .