AffidavitforQualifiedBidderStatusApril2011.pdf
PDF 46 KB Posted
- Attached to
- FLEX INSIGHT WORKSTATIONS
- Solicitation number
- RFQ 095 1900000008 1
- Issued by
- Elliott County, Kentucky
About this file
This is an Affidavit for Qualified Bidder Status form required by the State of Kentucky for bidders and contractors claiming qualified bidder status on state and local contracts. The form applies to the Flex Insight Workstations procurement opportunity in Kentucky and serves as a sworn statement under penalty of perjury that bidding entities and all subcontractors meet the requirements established under 200 KAR 5:410(3) and will maintain compliance throughout the contract term.
Bidders claiming qualified bidder status must identify their specific classification, with two options available: a nonprofit corporation that furthers the purposes of KRS Chapter 163, or a qualified nonprofit agency for individuals with severe disabilities as defined under KRS 45A.465(3). The latter designation requires the organization to be properly organized and operated for individuals with severe disabilities, maintain compliance with applicable occupational health and safety laws, employ individuals with severe disabilities for at least seventy-five percent of direct labor hours in manufacturing or providing products or services, and maintain active registration as a nonprofit organization with the Kentucky Secretary of State. The bidding agency retains the right to request supporting documentation of qualified bidder status claims, and failure to provide such documentation upon request may result in bidder disqualification or contract termination.
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Text version
Solicitation/Contract #: _________________________
REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS
CLAIMING QUALIFIED BIDDER STATUS
FOR BIDS AND CONTRACTS IN GENERAL:
I. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, and all subcontractors therein, meets the requirements to be considered a “qualified bidder” in accordance with 200 KAR 5:410(3); and will continue to comply with such requirements for the duration of any contract awarded. Please identify below the particular “qualified bidder” status claimed by the bidding entity.
________ A nonprofit corporation that furthers the purposes of KRS Chapter 163
_______ Per KRS 45A.465(3), a "Qualified nonprofit agency for individuals with severe disabilities" means an organization that:
(a) Is organized and operated in the interest of individuals with severe disabilities; and
(b) Complies with any applicable occupational health and safety law of the United States and the Commonwealth; and
(c) In the manufacture or provision of products or services listed or purchased under KRS
45A.470, during the fiscal year employs individuals with severe disabilities for not less than seventy-five percent (75%) of the man hours of direct labor required for the manufacture or provision of the products or services; and
(d) Is registered and in good standing as a nonprofit organization with the Secretary of
State.
The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of qualified bidder status. Failure to provide such documentation upon request may result in disqualification of the bidder or contract termination.
Signature Printed Name
Title Date
Company Name
Address
Subscribed and sworn to before me by
(Affiant) (Title) of this _____day of ____________,20___.
(Company Name)
Notary Public
[seal of notary] My commission expires:
http://www.lrc.ky.gov/kar/200/005/410.htm
File details come from the government source that posted it. Updated .