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

DOCX document 111 KB Posted

Attached to
Drill and Blasting D-11 STATE
Solicitation number
RFB 605 2400000019 2
Issued by
Carter County, Kentucky

About this file

This is an affidavit document required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded state contracts. The affidavit, effective for one year from the date of execution, is mandated under Kentucky Revised Statutes 45A.110 and 45A.115. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit it to the Commonwealth to qualify for contract award or contract renewal. The affidavit does not specify particular products, services, project scopes, timelines, or contract terms, as it serves as a standardized compliance document applicable across multiple procurement opportunities.

The affidavit requires the contractor's authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not violate any provision of those laws. "Knowingly" is defined as awareness or should-have-been awareness of a violation's existence. The Commonwealth reserves the right to request an updated affidavit at any time during the contract period. The document requires completion of contractor information including name, address, and Kentucky vendor code, along with notarization by a qualified notary public with current commission credentials. No pricing, set-asides, or funding information is contained in this compliance document.

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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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