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

DOCX document 111 KB Posted

Attached to
Liquid Asphalt 2024
Solicitation number
RFB 605 2400000337 1
Issued by
Kentucky

About this file

This is a Required Affidavit for Bidders, Offerors and Contractors mandated by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit must be completed and submitted by any bidder, offeror, or contractor seeking to be awarded a contract or renew an existing contract with the Commonwealth. An authorized representative of the contracting party is required to complete the attestation, obtain notarization, and return the completed affidavit to the Commonwealth. The affidavit is effective for one year from the date of execution and the Commonwealth retains the right to request an updated affidavit at any time during the contract term.

The attestation requires the bidder or contractor to swear and affirm under penalty of perjury that the contractor has not knowingly violated campaign finance laws of the Commonwealth of Kentucky and that the award of the contract will not violate any provision of such laws. For purposes of the attestation, "knowingly" is defined as awareness or should-be awareness of the existence of a violation. The document requires standard information including the bidder or offeror name, address, Commonwealth of Kentucky Vendor Code if known, notarization details including the notary signature and commission expiration date, and the signature, printed name, title, and date of the authorized representative completing the affidavit.

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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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