Annual Affidavit - 1-17-2023.docx.pdf
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- Attached to
- KY Unemployment Laws & Regulations Books
- Solicitation number
- RFQ 758 2500000005 3
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit form for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit serves as a mandatory submission requirement for any entity seeking to be awarded a state contract or to renew an existing contract with Kentucky. An authorized representative of the contracting party must complete the attestation, obtain notarization, and return the executed document to the Commonwealth. The affidavit remains effective for one year from the date of execution, after which updated affidavits may be required at the Commonwealth's discretion.
The attestation requires the authorized representative to swear under penalty of perjury that the bidder or contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not violate any provision of those laws. "Knowingly" is defined as awareness or reasonable awareness of a violation's existence. The affidavit form requires completion of bidder or offeror name, address, vendor code if available, signature of authorized representative with title and date, and notarization including the notary's commission expiration date and identification number. This affidavit is a prerequisite to contract eligibility and represents a compliance verification mechanism under Kentucky state procurement regulations.
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Text version
Rev. 9-16-22
Required Affidavit for Bidders, Offerors and Contractors
(KRS 45A.110 & 45A.115)
Affidavit Effective for One (1) Year from Date of Execution
Instructions: Pursuant to KRS 45A.110 and 45A.115, a bidder, offeror, or contractor
(“Contractor”) is required to submit a Required Affidavit for Bidders, Offerors, and Contractors to be awarded a contract, or for the renewal of a contract. An authorized representative of the contracting party must complete the attestation below, have the attestation notarized, and return the completed affidavit to the Commonwealth.
Attestation
As a duly authorized representative for the Contractor, I swear and affirm under penalty of perjury, that that the Contractor has not knowingly violated campaign finance laws of the Commonwealth of Kentucky and that the award of a contract will not violate any provision of the campaign finance laws of the Commonwealth. For purposes of this attestation, "Knowingly" means that the bidder or offeror is aware or should have been aware of the existence of a violation. The bidder or offer understands that the Commonwealth retains the right to request an updated affidavit at any time.
Signature Printed Name
Title Date
Bidder or Offeror Name: __________________________________________________________
Address: __________________________________________________________
Commonwealth of Kentucky Vendor Code (If known): _______________
Subscribed and sworn to before me this _____ day of _______________, ____________.
State of: ___________________ Notary: ___________________________________
County of: _________________ My Commission Expires: _____________________
Notary Commission ID Number:_______________________ https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22348 https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22349
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