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 required by the Transit Authority of Lexington-Fayette Urban County Government (Lextran) in connection with a snow removal services contract opportunity. The form must be completed and notarized by any proposer or subcontractor claiming DBE status. The affidavit requires the authorized representative of the applicant company to declare under penalty of perjury that the firm qualifies as a DBE as defined by specifications and commits to providing documentation to verify this status. The form includes spaces for company name, address, the declarant's title and signature, the date of execution, and notarization by a public notary.
The affidavit serves as a compliance document within Lextran's procurement process for the snow removal services RFP (Reference Number 2026-04), with proposals due by 2:00 pm eastern time on Wednesday, June 3, 2026. This form is relevant to bidders seeking to leverage potential DBE set-asides or preferences that may be available in the award evaluation criteria. Proposers should ensure accurate completion and timely notarization of this document as part of their overall proposal submission package to maintain responsiveness to RFP requirements.
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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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