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

DOCX document 111 KB Posted

Attached to
Demo Svc Rowan Co P. 55, 110, and 148
Solicitation number
RFB 605 2400000284 1
Issued by
Rowan County, Kentucky

About this file

This is an affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded or renew state contracts. The document, effective for one year from the date of execution, mandates that an authorized representative of the contracting party complete the attestation, have it notarized, and submit it to the Commonwealth pursuant to Kentucky Revised Statutes 45A.110 and 45A.115. The affidavit serves as a prerequisite for contract award or renewal and requires the contractor to affirm under penalty of perjury that it has not knowingly violated Kentucky campaign finance laws and that the award of a contract will not violate any provision of such laws. The term "knowingly" is defined as awareness or constructive awareness of a violation's existence.

The affidavit requires the authorized representative's signature, printed name, title, and date, along with the bidder or offeror's legal name, address, and Commonwealth of Kentucky vendor code if available. The document must be subscribed and sworn before a notary public, who must provide their signature, the date of execution, the state and county where notarization occurred, and the expiration date of their commission. The Commonwealth retains the right to request an updated affidavit at any time during the contract period or renewal process. No specific pricing terms, set-asides, or funding requirements are addressed in this compliance document.

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IMPROVEMENTS TO BE REMOVED (1).pdf 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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