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

DOCX document 111 KB Posted

Attached to
Eq Rental w/Operator D-1
Solicitation number
RFB 605 2300000564 1
Issued by
Johnson County, Kentucky

About this file

This is a Required Affidavit for Bidders, Offerors and Contractors document issued by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit is mandatory for all bidders, offerors, and contractors seeking to be awarded a contract or to renew an existing contract with the Commonwealth. 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.

The attestation requires the authorized representative to swear and affirm under penalty of perjury 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 Commonwealth's campaign finance laws. For purposes of this attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation. The Commonwealth retains the right to request an updated affidavit at any time during the contract period. The document must include the contractor's name, address, Commonwealth of Kentucky Vendor Code if known, the authorized representative's signature, printed name, title, and date, as well as notarization by a qualified notary public with commission expiration date.

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District Map.pdf PDF
How to Respond to Online Bid through Kentucky Vendor Self....pdf PDF
Final_RFB_605_2300000564_1_SO_FORM.PDF PDF
Vendor Bid Sheet.xls XLS spreadsheet

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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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