Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- Rubber-Tired Loader (Buyback) FY24
- Solicitation number
- RFB 605 2400000390 2
- Issued by
- Fayette County, Kentucky
About this file
This is a Required Affidavit form for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit must be completed and notarized by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or renew an existing contract with the Commonwealth. The attestation requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that the contract award will not violate any provision of those laws. The affidavit is effective for one year from the date of execution, and the Commonwealth retains the right to request an updated affidavit at any time during the contract term.
The form requires submission of basic contractor information including the bidder or offeror name, address, and Commonwealth of Kentucky vendor code if known. An authorized representative must sign the document in the presence of a notary public, who must also sign and provide their notarization information, including the date, state, county, and commission expiration date. The definition of "knowingly" for purposes of the attestation means the bidder or offeror is aware or should have been aware of the existence of a violation of Kentucky campaign finance laws.
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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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