AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Bus Stop Enhancements
- Solicitation number
- 2026-05
- Issued by
- Fayette County, Kentucky
About this file
This is an Affidavit of Compliance form for Disadvantaged Business Enterprises (DBEs) related to the Bus Stop Enhancements Request for Proposals issued by the Transit Authority of Lexington-Fayette Urban County Government (Lextran) in Kentucky. The form is to be completed only by proposers or subcontractors who qualify as DBEs. Proposals for the bus stop enhancement services contract are due by 2:00 pm Eastern Time on Thursday, June 18, 2026, and must be submitted online through Lextran's eProcurement Portal. Questions and requests for clarification must be submitted by end of day on Friday, May 22, 2026, with responses provided through the portal's Q&A section or via addendum if documentation changes are required.
The affidavit requires the authorized representative of the DBE firm to declare under penalty of perjury that the company qualifies as a Disadvantaged Business Enterprise as defined by specifications and that they will provide requested documentation to verify this status. The form must be notarized and signed by both the authorized company representative and a notary public. Lextran reserves the right to reject incomplete or non-responsive submissions, cancel or reissue the RFP, waive minor technical deficiencies, and evaluate proposals at its sole discretion.
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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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