AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Electrician Services
- Solicitation number
- 2023-03
- Issued by
- Mclean County, Kentucky
About this file
This document is an Affidavit of Compliance for Disadvantaged Business Enterprise (DBE) certification issued by Lextran, the Transit Authority of 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 and affirm their DBE status as defined by the specifications. The affidavit requires the company representative to provide company information, declare their DBE status, and commit to providing additional documentation if requested by Lextran.
The affidavit is a standard legal document that includes provisions for the authorized representative to solemnly declare under penalties of perjury that the contents are true and correct. It requires a signature from the company representative, a notarized verification, and includes spaces for the date, authorized signature, printed name, notary public details, and notary commission expiration. While the document does not specify specific contract details, it is part of a procurement process that appears to be related to Lextran's Request for Proposals for electrician services (Reference Number: 2023-03), with proposals due by 3:00 pm eastern time on Thursday, August 24, 2023.
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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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