AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf

608 KB Posted

Attached to
Bus Shelters, Benches, & Trash Receptacles
Solicitation number
2023-10
Issued by
Essex County, Kentucky

About this file

Written by GovTribe AI ·

This document is an Affidavit of Compliance for a Disadvantaged Business Enterprise (DBE), issued by Lextran, the transit authority for Lexington-Fayette Urban County. The affidavit is a standard form to be completed by proposers or subcontractors who qualify as a Disadvantaged Business Enterprise, requiring the authorized representative to declare their DBE status and commitment to provide documentation to Lextran as requested. The form requires the company representative to affirm their DBE classification under penalty of perjury, with spaces for signature, date, and notarization.

The affidavit serves as a formal declaration of a company's DBE status, which is likely related to Lextran's procurement processes that aim to promote diversity and inclusion in contracting. While the specific contract details are not part of this document, the form suggests Lextran has established procedures for verifying and documenting DBE participation in its procurement opportunities. The form provides a legal mechanism for businesses to assert their DBE credentials and agree to provide additional supporting information as needed by the transit authority.

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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 .