Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- POTHOLE SPRAY PATCHER D-4
- Solicitation number
- RFB 605 2300000503 1
- Issued by
- Elliott County, Kentucky
About this file
This is an Annual Affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded or renew contracts 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 by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth. The form requires attestation that the contractor has not knowingly violated campaign finance laws of Kentucky and that contract award will not violate any provisions of such laws. The term "knowingly" is defined as awareness or should-have-been awareness of a violation's existence.
The affidavit requires the contractor to provide identifying information including company name, address, and Commonwealth vendor code if known. An authorized representative must sign the attestation under penalty of perjury, and a notary public must certify the signature with their name, commission expiration date, state, and county. The Commonwealth retains the right to request updated affidavits at any time during the contract period. This affidavit serves as a compliance prerequisite for contract award and renewal processes.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_605_2300000503_1_SO_FORM.PDF | ||
| How to Respond to Online Bid through Kentucky Vendor Self....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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