Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023 - Copy.docx

DOCX document 111 KB Posted

Attached to
Drill and Blasting D-11 FEDERAL
Solicitation number
RFB 605 2400000020 2
Issued by
Carter County, Kentucky

About this file

This is a Required Affidavit form for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky pursuant to KRS 45A.110 and 45A.115. The affidavit applies to all bidders, offerors, and contractors seeking to be awarded a contract or renew an existing contract with the Commonwealth of Kentucky. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The affidavit is effective for one year from the date of execution. No specific response dates, due dates, site visits, bidders' meetings, award dates, or contract terms are specified in this document, as it is a procedural compliance form rather than a solicitation.

The affidavit requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that awarding a contract will not violate any provision of the state's campaign finance laws. For purposes of this attestation, "knowingly" is defined as awareness or reasonable awareness of a violation's existence. The Commonwealth retains the right to request an updated affidavit at any time. The form requires the contractor's name, address, vendor code if known, the authorized representative's signature, printed name, and title, along with notarization including the notary's signature, commission expiration date, and the state and county where notarization occurred.

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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: _____________________

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