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
This is an Affidavit of Compliance form for Disadvantaged Business Enterprises (DBE) to be submitted by proposers or subcontractors seeking to establish their DBE status in relation to Lextran procurement opportunities. The form requires the authorized representative of a DBE firm to declare under penalty of perjury that the company qualifies as a Disadvantaged Business Enterprise as defined by Lextran's specifications. The affiant must provide their title, company name, and company address, and the declaration must be notarized with the notary public's signature, name, and commission expiration date included on the document.
The affidavit serves as a certification mechanism for firms pursuing contract opportunities with Lextran and requires the declarant to commit to providing documentation to substantiate DBE status upon request. This form is essential for any entity seeking consideration under DBE set-aside or preference programs within Lextran's procurement process and functions as a binding legal statement subject to perjury penalties to ensure the accuracy and legitimacy of DBE claims.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .