AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
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- Attached to
- Security & Access Control
- Solicitation number
- 2026-02
- Issued by
- Fayette County, Kentucky
About this file
This is an Affidavit of Compliance form for Disadvantaged Business Enterprise (DBE) certification related to the Transit Authority of Lexington-Fayette Urban County Government (Lextran) Security & Access Control contract opportunity in Kentucky. The form is to be completed and sworn by proposers or subcontractors who claim DBE status. The affidavit requires the authorized representative of the applicant firm to declare under penalties of perjury that the company qualifies as a Disadvantaged Business Enterprise as defined by the specifications and commits to providing documentation to verify this status upon request by Lextran. The document must be notarized, with the affiant's signature and printed name, the notary public's name and signature, and the notary's commission expiration date. The form is part of the submission requirements for the Security & Access Control RFP issued by Lextran, with proposals due by 2:00 pm eastern time on Wednesday, April 29, 2026.
The affidavit serves as a certification mechanism for firms seeking to qualify for DBE considerations in the Lextran contract award process. Completion of this form is mandatory only for proposers or subcontractors claiming DBE status and is used to verify eligibility for any potential set-asides or preference considerations associated with disadvantaged business classifications. The document requires state and county identification at the top, and the notarization requirement ensures the veracity of the declaration made by the authorized company representative.
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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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