AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Snow Removal
- Solicitation number
- 2026-04
- Issued by
- Fayette County, Kentucky
About this file
This is an Affidavit of Compliance form for Disadvantaged Business Enterprise (DBE) certification related to Lextran's (Transit Authority of Lexington-Fayette Urban County Government, Kentucky) Request for Proposals for snow removal services. The form is to be completed only by proposers or subcontractors that qualify as DBE entities. The affidavit requires the authorized representative to declare under penalty of perjury that their company meets DBE criteria as defined by Lextran's specifications and that they will provide requested documentation to verify this status. The RFP for snow removal services (Reference Number: 2026-04) has a proposal submission deadline of 2:00 pm eastern time on Wednesday, June 3, 2026, with all questions due by end of day on Friday, May 1, 2026. The contract term and renewal options are not specified in this form document.
The affidavit requires notarization by a public notary and must include the company name, address, authorized representative's title and signature, and notary commission expiration date. The form does not specify pricing terms, contract value, or other financial details. As a DBE certification form, it serves to establish eligibility for potential set-asides or preferences for disadvantaged business enterprises responding to Lextran's snow removal RFP. The document itself contains no information regarding incumbents, current environment, or specific funding sources, as it functions solely as a compliance verification tool for qualifying vendors.
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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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