AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
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- Solicitation number
- 2023-06
- Issued by
- Essex County, Kentucky
About this file
This document is an Affidavit of Compliance for Disadvantaged Business Enterprise (DBE) certification, issued by Lextran, the transit authority for Lexington-Fayette Urban County in Kentucky. The form is designed to be completed by proposers or subcontractors who qualify as a Disadvantaged Business Enterprise, requiring the authorized representative to declare their DBE status and affirm their commitment to providing documentation verifying their classification. The affidavit includes spaces for the company's details, a sworn declaration of DBE status, and requires notarization to validate the claim.
The affidavit serves as a formal mechanism for businesses to self-identify as a Disadvantaged Business Enterprise, which can potentially provide competitive advantages in municipal procurement processes. By executing this document, the business representative solemnly declares under penalty of perjury that the information provided is true and correct, and that they are authorized to represent the firm in this capacity. The form is a standard compliance document that supports diversity and inclusion objectives in government contracting, allowing DBE firms to document their status and eligibility for potential set-aside or preference considerations in bidding processes.
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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: |
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