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

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Attached to
Oil/Water Seperator for Statewide Use
Solicitation number
RFB 605 2300000827 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 state contracts. The affidavit is governed by Kentucky Revised Statutes (KRS) 45A.110 and 45A.115 and remains effective 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 form requires the contractor to swear under penalty of perjury that it has not knowingly violated Kentucky's campaign finance laws and that accepting the contract award will not violate any provision of the state's campaign finance laws. For purposes of this attestation, "knowingly" is defined as awareness or the reasonable expectation of awareness regarding a violation.

The affidavit includes fields for the contractor's signature, printed name, title, and date of execution, as well as the bidder or offeror's legal name, address, and Commonwealth of Kentucky vendor code if known. The form must be notarized with the notary's signature, the state and county where the oath was administered, and the notary's commission expiration date. The Commonwealth retains the right to request an updated affidavit at any time during the contract period. This document serves as a compliance mechanism ensuring that all contractors meet Kentucky's campaign finance law requirements prior to contract award or renewal.

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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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