Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- TRUCK TOOL BOXES
- Solicitation number
- RFB 605 2300000502 4
- 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 pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit applies to all contract awards and contract renewals within the Commonwealth. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit it to the Commonwealth. The affidavit is effective for one year from the date of execution. No specific products, services, quantities, response dates, or award dates are referenced in this document, as it serves as a general compliance requirement applicable across all state contracting opportunities.
The attestation requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that accepting the contract award will not violate any provision of those laws. "Knowingly" is defined as the bidder or offeror being aware or having reason to be aware of a violation. The Commonwealth reserves the right to request an updated affidavit at any time during the contract term. The form requires the contractor's name, address, vendor code, and notary information to be completed and sworn before a notary public.
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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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