Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- TRENCH BOX
- Solicitation number
- RFB 605 2400000179 2
- Issued by
- Elliott County, Kentucky
About this file
This is an Annual Affidavit for Bidders, Offerors, and Contractors required by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit is a mandatory compliance document that must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or renew an existing contract with the state. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit it to the Commonwealth. The affidavit is effective for one year from the date of execution.
The attestation requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any campaign finance law provisions. "Knowingly" is defined as awareness or should-have-been awareness of a violation. The Commonwealth retains the right to request an updated affidavit at any time. The document requires completion of contractor information including name, address, and vendor code, along with the signature, printed name, and title of the authorized representative, date of execution, and notarization details including the notary's signature, state and county, and commission expiration date.
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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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