AFFIDAVIT_OF_COMPLIANCE_-_DISADVANTAGED_BUSINESS_ENTERPRISE.pdf
PDF 608 KB Posted
- Attached to
- Architectural & Engineering Services and Transit Planning Services State and local contract opportunity
- Solicitation number
- 2024-11
- Issued by
- Fayette County, Kentucky
About this file
The document is an Affidavit of Compliance for Disadvantaged Business Enterprise (DBE) from Lextran, a transportation agency. This affidavit is a form to be completed by proposers or subcontractors who qualify as a Disadvantaged Business Enterprise for a contract opportunity. The form requires the authorized representative to declare and affirm their status as a DBE and provide documentation to Lextran upon request.
The affidavit is a formal legal document that requires the signatory to swear under penalties of perjury that the information provided is true and correct. It includes spaces for the company's state and county, the representative's title, company name, and address. The form must be signed by the authorized representative, dated, and then notarized, with the notary public providing their name, signature, and commission expiration date. This document is likely part of a procurement process that aims to ensure opportunities for disadvantaged businesses in government contracting.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Architectural_&_Engineering_Services_and_Transit_Planning_Services_(Addendum_#1_Revision).pdf | ||
| CERTIFICATION_OF_CONTRACTOR_REGARDING_DEBARMENT,_SUSPENSION,_AND_OTHER_INELIGIBILITY_AND_VOLUNTARY_EXCLUSION.pdf | ||
| FINANCIAL_CAPACITY_FORM.pdf | ||
| CERTIFICATE_OF_PROCUREMENT_INTEGRITY.pdf | ||
| CERTIFICATION_OF_RESTRICTIONS_ON_LOBBYING.pdf | ||
| NON-COLLUSION_AFFIDAVIT.pdf |
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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: |
File details come from the government source that posted it. Updated .