Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Solicitation number
- RFB 605 2300000783 3
- Issued by
- Wayne County, Kentucky
About this file
This is an Annual Affidavit for Bidders, Offerors and Contractors required by the Commonwealth of Kentucky pursuant to 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 contract renewal with the state. The affidavit is effective for one year from the date of execution and attests that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of Kentucky campaign finance law. "Knowingly" is defined as awareness or reasonable awareness of a violation's existence.
The Commonwealth retains the right to request an updated affidavit at any time during the contract period. The completed affidavit must include the contractor's name, address, Commonwealth of Kentucky vendor code if known, signature and printed name of the authorized representative with title and date, and notarization by a notary public including the notary's name, commission expiration date, and the state and county where the affidavit was notarized. No pricing, funding, or specific contract terms are addressed in this affidavit document, as it serves solely as a compliance certification requirement for contract eligibility.
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| File | Type | Posted |
|---|---|---|
| How to Submit an Online Response - March 2023.pdf | ||
| Disability Form.docx | DOCX document | |
| TC 71-126 revised Jan 2023.pdf | ||
| Final_RFB_605_2300000783_2_SO_FORM.PDF | ||
| Final_RFB_605_2300000783_1_SO_FORM.PDF | ||
| Final_RFB_605_2300000783_3_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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