Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx

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Attached to
FUEL TRANSFER TANKS
Solicitation number
RFB 605 2300000457 1
Issued by
Elliott County, Kentucky

About this file

This is an annual affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded or renew contracts under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be completed by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth prior to contract award or renewal. The form requires attestation that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of those laws. "Knowingly" is defined as the bidder or offeror being aware or should have been aware of a violation. The Commonwealth retains the right to request an updated affidavit at any time during the contract term.

The affidavit requires collection of standard contractor identification information including legal name, address, and Commonwealth vendor code if available. The document must be executed under penalty of perjury and notarized before a notary public who must provide their state, county, commission expiration date, and the date of notarization. This affidavit serves as a compliance verification mechanism for campaign finance requirements and is a mandatory submission document for all bidders and contractors engaging with the Commonwealth of Kentucky.

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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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