Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Solicitation number
- RFB 605 2400000292 1
- Issued by
- Breathitt County, Kentucky
About this file
This is an affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking state contract awards or contract renewals under Kentucky Revised Statutes 45A.110 and 45A.115. The affidavit serves as a one-year certification and must be completed by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth prior to contract award or renewal. The document requires attestation 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 affidavit form includes fields for the contractor's signature, printed name, title, date of execution, bidder or offeror name, address, and Commonwealth vendor code. An authorized representative must swear under penalty of perjury that the contractor meets the campaign finance compliance requirements. The form must be notarized with the notary's signature, commission expiration date, and state and county information. The Commonwealth retains the right to request an updated affidavit at any time during the contract period. "Knowingly" is defined as awareness or constructive awareness of a violation.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_605_2400000292_1_SO_FORM.PDF | ||
| Disability Form.docx | DOCX document | |
| How to Submit an Online Response - March 2023.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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