Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- Rapid Hardening Concrete Patching Material REBID
- Solicitation number
- RFB 605 2400000529 1
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky pursuant to Kentucky Revised Statutes (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 renewal of an existing contract with the Commonwealth. The affidavit is effective for one year from the date of execution. No specific products, services, quantities, response dates, or contract terms are outlined in this document, as it serves as a general compliance requirement applicable across all Commonwealth procurement activities.
The affidavit requires the authorized representative to attest under penalty of perjury that the contracting party has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of such laws. "Knowingly" is defined as awareness or should-be awareness of a violation's existence. The Commonwealth reserves the right to request updated affidavits at any time. The document requires the contractor's signature, printed name, title, date of execution, bidder or offeror name and address, Commonwealth vendor code if available, notarization with date and notary information, and notary commission expiration date.
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Other files
| File | Type | Posted |
|---|---|---|
| District Map (4).pdf | ||
| How to Submit an Online Response - March 2023.pdf | ||
| Final_RFB_605_2400000529_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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