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

DOCX document 111 KB Posted

Attached to
Concrete Testing Equipment
Solicitation number
RFB 605 2400000209 2
Issued by
Elliott County, Kentucky

About this file

This is an affidavit form issued by the Commonwealth of Kentucky for bidders, offerors, and contractors required under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit serves as a mandatory attestation that must be completed, notarized, and submitted to the Commonwealth prior to contract award or contract renewal. An authorized representative of the bidder or contractor must execute the document under penalty of perjury, confirming that the contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not result in any violation of such laws. The affidavit is effective for one year from the date of execution, and the Commonwealth retains the right to request updated affidavits at any time during the contract period.

The form requires completion of contractor identification information, including company name, address, and vendor code if known. The attestation must be notarized before a notary public, with the notary providing their signature, commission expiration date, and the state and county where the oath is administered. The definition of "knowingly" for purposes of this attestation includes any violation of which the bidder or offeror is aware or should reasonably be aware. No specific pricing, set-asides, or funding information is addressed in this document, as it functions solely as a compliance and legal attestation requirement for Kentucky state contracting.

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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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