Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Solicitation number
- RFB 605 2300000800 2
- Issued by
- Casey County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky in compliance with Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be submitted by bidders, offerors, or contractors to be awarded a contract or for contract renewal. An authorized representative of the contracting party must complete the attestation, obtain notarization, and return the completed affidavit to the Commonwealth. The form requires the contractor to swear under penalty of perjury that it has not knowingly violated campaign finance laws of Kentucky and that contract award will not violate any provision of those laws.
The affidavit includes fields for the contractor's signature, printed name, title, date of execution, bidder or offeror name, address, and Commonwealth of Kentucky vendor code. The document defines "knowingly" as meaning the bidder or offeror is aware or should have been aware of a violation's existence. The attestation must be notarized with the notary providing their signature, commission expiration date, and the state and county where the notarization occurs. The Commonwealth reserves the right to request an updated affidavit at any time during the contract period.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_605_2300000800_1_SO_FORM.PDF | ||
| Disability Form.docx | DOCX document | |
| TC 71-126 revised Jan 2023.pdf | ||
| How to Submit an Online Response - March 2023.pdf | ||
| Final_RFB_605_2300000800_2_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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