Affidavit_Regarding_Worker's_Compensation.docx
DOCX document 46 KB Posted
- Solicitation number
- 26-045-ITB
- Issued by
- Kenton County, Kentucky
About this file
This is an Affidavit Regarding Worker's Compensation form required by the Kenton County Airport Board, operator of the Cincinnati/Northern Kentucky International Airport in Kentucky. The affidavit serves as a compliance assurance document that must be executed by contractors awarded contracts for the Runway 18L/36R Tunnel Rehabilitation & Safety Improvements project. The form requires the contractor to affirm that all contractors and subcontractors employed under the contract will maintain compliance with Kentucky's worker's compensation insurance requirements as specified in KRS Chapter 342 and unemployment insurance requirements under KRS Chapter 341. A pre-proposal meeting and site visit for the project are scheduled for Wednesday, August 19, 2026 at 1:00 pm at CVG Centre, 77 Comair Blvd., Erlanger, KY 41048. Questions must be submitted by 11:59 pm on Monday, August 24, 2026, with answers to be posted no later than Friday, August 28, 2026 at 11:59 pm. Proposals are due by Thursday, September 3, 2026 at 2:00 pm, with no proposals accepted after that deadline unless an addendum extends the date or time.
The affidavit must be signed by an authorized representative of the contractor and notarized before a notary public. This document is a mandatory submission requirement for contract award and demonstrates the contractor's commitment to maintaining statutory compliance with Kentucky labor and insurance regulations throughout the performance of the contract.
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Text version
KENTON COUNTY AIRPORT BOARD CINCINNATI/NORTHERN KY INTERNATIONAL AIRPORT
PROJECT NAME
AFFIDAVIT REGARDING WORKER'S COMPENSATION
The undersigned Contractor, being awarded a Contract by the Kenton County Airport Board, operator of the Cincinnati/Northern Kentucky International Airport, identified as: ________________________________ hereby assures that all Contractors and subcontractors employed, or that will be employed, under the provisions of the foregoing identified contract shall be in compliance with Kentucky requirements for Worker's Compensation Insurance according to KRS Chapter 342 and unemployment insurance according to KRS Chapter 341.
DATED this day of , 20____.
Signature: ___________________________________________________
Name and Title (Printed):
STATE OF
COUNTY OF
Subscribed and sworn to before me, a Notary Public, by ________ , on behalf of the foregoing identified Contractor this day of ____ 20 .
Notary Public
My Jurisdiction is:
My Commission Expires:
END OF SECTIO
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