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

DOCX document 111 KB Posted

Attached to
Freeze-Thaw Machine-REBID
Solicitation number
RFB 605 2300000515 2
Issued by
Elliott 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 is mandated for all bidders, offerors, and contractors seeking to be awarded a contract or to renew an existing contract with the state. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The affidavit remains effective for one year from the date of execution. No specific products, services, project overviews, quantities, response dates, due dates, site visits, bidder meetings, award dates, or contract terms are detailed in this document, as it serves as a standalone compliance requirement applicable across all state procurement activities.

The affidavit requires the authorized representative to attest under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of those laws. The term "knowingly" is defined as awareness or the reasonable awareness of the existence of a violation. The Commonwealth retains the right to request an updated affidavit at any time during the contract period. The document includes fields for the bidder or offeror name, address, vendor code, signature, printed name, title, date, and notary information. No pricing terms, set-asides, incumbent information, or funding requirements are addressed in this compliance document.

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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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