Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- DEMOLITION Breathitt Co. 10-0376. 00 P. 22
- Solicitation number
- RFB 605 2300000771 3
- Issued by
- Breathitt County, Kentucky
About this file
This is an Annual Affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit serves as a mandatory submission requirement for entities seeking to be awarded a contract or for contract renewal with the Commonwealth of Kentucky. The affidavit is valid for one year from the date of execution. An authorized representative of the contracting party must complete the attestation, have it notarized, and submit it to the Commonwealth.
The affidavit requires the bidder or offeror to attest under penalty of perjury that the contractor has not knowingly violated campaign finance laws of the Commonwealth of Kentucky and that awarding the contract will not violate any provision of Kentucky's campaign finance laws. "Knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation. The form includes sections for the contractor's signature, printed name, title, date, bidder or offeror name and address, Commonwealth of Kentucky vendor code if known, notary information, and notarization date and expiration of the notary's commission. The Commonwealth retains the right to request an updated affidavit at any time during the contract period.
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Other files
| File | Type | Posted |
|---|---|---|
| 10-0376.00 AERIAL.pdf | ||
| 10-0376.00 PLAN PAGE.pdf | ||
| Final_RFB_605_2300000771_3_SO_FORM.PDF | ||
| 10-0376.00 IMPROVEMENT PHOTOS.pdf | ||
| How to Submit an Online Response - March 2023.pdf | ||
| Final_RFB_605_2300000771_1_SO_FORM.PDF | ||
| Final_RFB_605_2300000771_2_SO_FORM.PDF | ||
| Bid Sheet - Demo.xlsx | XLSX spreadsheet |
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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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