Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- BRUSH CHIPPER HEAVY DUTY D-10 FE FUNDING
- Solicitation number
- RFB 605 2300000600 3
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky in accordance with KRS 45A.110 and 45A.115. The affidavit must be completed and submitted by any bidder, offeror, or contractor seeking to be awarded a contract or renewing an existing contract with the state. An authorized representative of the contracting party is required to complete the attestation, have it notarized, 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's campaign finance laws and that awarding the contract will not violate any provision of those laws. For purposes of this attestation, "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. The completed document must include the bidder or offeror's name, address, Commonwealth Vendor Code if known, authorized representative's signature, printed name, title, date, notary information including the state and county where notarized, notary signature, and the date the notary's commission expires.
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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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