AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf

PDF 608 KB Posted

Attached to
Environmental Services
Solicitation number
2022-13
Issued by
Essex County, Kentucky

About this file

Written by GovTribe AI ·

The document is an Affidavit of Compliance for a Disadvantaged Business Enterprise (DBE) form issued by Lextran, a transit agency 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 provide documentation upon request. The affidavit serves as a sworn statement affirming the company's DBE classification and authorizing the representative to execute the document on behalf of their firm.

The form requires the completion of standard legal documentation, including state and county information, company details, an authorized signature, and notarization. By executing this affidavit, the business representative solemnly declares under penalties of perjury that the information provided is true and correct. While this specific document does not contain pricing or contract details, it is part of the procurement process for Lextran's environmental services contract, which involves compliance and verification of a proposer's disadvantaged business enterprise status.

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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 .