Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
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- Attached to
- OMNI-DIRECTIONAL QUAD CAMERA w/REMOTE SETUP
- Solicitation number
- RFB 605 2300000676 1
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors mandated by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or to renew an existing contract with the Commonwealth. An authorized representative of the contracting party must complete the attestation, have it notarized, and return the completed affidavit to the Commonwealth. The affidavit is effective for one year from the date of execution and may be updated at any time at the Commonwealth's request.
The attestation requires the authorized representative to swear and affirm under penalty of perjury 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 Kentucky's campaign finance laws. "Knowingly" is defined as awareness or reasonable awareness of the existence of a violation. The affidavit form requires completion of contractor information including name, address, and vendor code, along with the authorized representative's signature, printed name, title, and date, followed by notarization with the notary's signature, commission expiration date, and state and county of notarization.
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Other files
| File | Type | Posted |
|---|---|---|
| FHWA-1273.pdf | ||
| How to Submit an Online Response - March 2023.pdf | ||
| Buy America Clause.pdf | ||
| Final_RFB_605_2300000676_1_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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