Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Solicitation number
- RFB-605-2400000457-2
- Issued by
- Pike County, Kentucky
About this file
The document provided is an "Annual Affidavit for Bidders, Offerors and Contractors" required by the Commonwealth of Kentucky for awarding or renewing a contract. It details the attestation that a duly authorized representative of the bidder or offeror must complete, have notarized, and submit to the Commonwealth. The attestation affirms that the bidder or offeror has not knowingly violated the campaign finance laws of the Commonwealth of Kentucky and that the award of the contract will not violate any provision of the campaign finance laws.
The related state and local contract opportunity is for the "Equip. Rental Offset Drill w/operator District 12 - FHWA" in Pike County, Kentucky. The contract is funded by the Federal Highway Administration (FHWA). No other details about the products, services, quantities, response dates, or contract term are provided in the information given.
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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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