AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Uniforms - Operators
- Solicitation number
- 2023-01
- Issued by
- Mclean County, Kentucky
About this file
This document is an Affidavit of Compliance for Disadvantaged Business Enterprise (DBE) from 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. The affidavit includes spaces for the company's details, a sworn declaration of compliance with DBE specifications, and requires notarization to validate the document's authenticity.
The affidavit serves as a formal declaration by a business asserting its DBE classification, with the signatory affirming under penalty of perjury that they will provide any requested documentation to Lextran to substantiate their DBE status. By executing this document, the company commits to being transparent about its business classification and agrees to cooperate with Lextran's verification processes. The form includes standard legal elements such as spaces for the date, authorized signature, printed name, and notary public certification, ensuring a comprehensive and legally binding attestation of the company's DBE credentials.
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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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