Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- Eq Rental w/Operator D-1 FHWA ER Eligible
- Solicitation number
- RFB 605 2300000573 1
- Issued by
- Jessamine County, Kentucky
About this file
This document is a Required Affidavit for Bidders, Offerors, and Contractors mandated by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or for contract renewal with the state of Kentucky. An authorized representative of the contracting party is required to complete the attestation, have it notarized, and submit it to the Commonwealth. The form requires bidders to provide their company name, address, and Commonwealth of Kentucky vendor code if applicable.
The attestation requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that awarding the contract will not violate any campaign finance law provisions. For purposes of this affidavit, "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 during the contract period. The document must be notarized with identification of the notary's state and county, commission expiration date, and the specific date of execution.
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Other files
| File | Type | Posted |
|---|---|---|
| Vendor Bid Sheet.xls | XLS spreadsheet | |
| How to Respond to Online Bid through Kentucky Vendor Self....pdf | ||
| Final_RFB_605_2300000573_1_SO_FORM.PDF |
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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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