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

DOCX document 111 KB Posted

Attached to
Mat and Towel Rental/Service - District 6 REBID
Solicitation number
RFB 605 2300000697 1
Issued by
Boone County, Kentucky

About this file

This is a Required Affidavit for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be completed and notarized by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or for contract renewal with the Commonwealth. An authorized representative must attest under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that the contract award will not violate any campaign finance provisions. The document requires the contractor's signature, printed name, title, execution date, bidder or offeror name, address, and vendor code (if known).

The affidavit must be notarized before a notary public, with the notary providing their signature, the execution date, state and county information, and notary commission expiration date. The Commonwealth of Kentucky retains the right to request an updated affidavit at any time during the contract period. For purposes of the attestation, "knowingly" is defined as awareness or reasonable awareness of a campaign finance law violation. No specific pricing, set-asides, or funding information is contained in this document, as it serves solely as a compliance certification requirement for contract eligibility.

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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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