Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Solicitation number
- RFB 605 2300000782 3
- Issued by
- Breckinridge County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors mandated by the Commonwealth of Kentucky pursuant to KRS 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be completed by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or requesting renewal of an existing contract with the state. The document requires notarization and submission to the Commonwealth as a prerequisite for contract award consideration.
The affidavit constitutes an attestation under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of the state's campaign finance laws. "Knowingly" is defined as awareness or constructive awareness of a violation's existence. The form requires the contractor's authorized representative signature, printed name, title, execution date, notary certification with expiration date of commission, and bidder information including entity name, address, and Commonwealth Vendor Code. The Commonwealth retains the right to request updated affidavits at any time during the contract term.
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Other files
| File | Type | Posted |
|---|---|---|
| How to Submit an Online Response - March 2023.pdf | ||
| Final_RFB_605_2300000782_1_SO_FORM.PDF | ||
| TC 71-126 revised Jan 2023.pdf | ||
| Final_RFB_605_2300000782_2_SO_FORM.PDF | ||
| Final_RFB_605_2300000782_3_SO_FORM.PDF | ||
| Disability Form.docx | DOCX document |
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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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