Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- 2024 KIT and IFTA Decals
- Solicitation number
- RFB 605 2300000607 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 contracts with the state. The affidavit is mandated under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115 and remains valid for one year from the date of execution. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth to satisfy eligibility requirements for contract award or renewal.
The attestation requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that the contract award will not violate any provision of those laws. The term "knowingly" is defined as awareness or should-be awareness of a violation's existence. The Commonwealth retains the right to request updated affidavits at any time. The form requires the contractor's signature, printed name, title, date of execution, bidder or offeror name, complete address, vendor code if known, notary information including the notary's signature and commission expiration date, and the state and county where the affidavit is notarized.
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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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