Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- Demolition Svc Martin Co P. 03
- Solicitation number
- RFB 605 2400000543 3
- Issued by
- Letcher County, Kentucky
About this file
This is an Annual Affidavit for Bidders, Offerors and Contractors required by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit must be completed and notarized by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or renew an existing contract with the Commonwealth. The attestation certifies that the Contractor has not knowingly violated campaign finance laws of Kentucky and that contract award will not violate any provision of the Commonwealth's campaign finance laws. The affidavit is effective for one year from the date of execution.
The document requires completion of contractor information including name, address, and vendor code, along with the authorized representative's signature, printed name, title, and date. Notarization is mandatory, with the notary providing their signature, commission expiration date, state, and county of notarization. The Commonwealth retains the right to request an updated affidavit at any time during the contract period. For purposes of the attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation.
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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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