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

DOCX document 111 KB Posted

Attached to
Janitorial Services: Shelby Co. I-64 Welcome Center
Solicitation number
RFB 605 2300000779 3
Issued by
Spencer County, Kentucky

About this file

This is a Required Affidavit for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky, effective under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit is valid for one year from the date of execution and must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the Commonwealth. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The document requires the authorized representative to swear and affirm under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that awarding the contract will not violate any provision of the state's campaign finance laws. For purposes of this attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation.

The affidavit form includes fields for the contractor's name, address, Commonwealth of Kentucky vendor code, signature of the authorized representative, printed name, title, and date of execution. The document must be notarized before a notary public, with the notary providing their signature, the state and county where the attestation occurred, the date of notarization, and the expiration date of the notary's commission. The Commonwealth retains the right to request an updated affidavit at any time during the contract period.

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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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