Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- HEATED ASPHALT TRAILERS
- Solicitation number
- RFB 605 2400000022 4
- Issued by
- Elliott 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 state. The document serves as a sworn attestation that remains effective for one year from the date of execution. There are no specific products, services, quantities, response dates, due dates, site visits, bidder meetings, award dates, or contract terms outlined in this form, as it is a standardized compliance document applicable across all state contract opportunities.
The affidavit requires the contractor's authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not violate any provision of those laws. "Knowingly" is defined as awareness or the reasonable expectation of awareness regarding a violation. The document requires the contractor to provide its name, address, and Commonwealth of Kentucky Vendor Code, along with notarization by an authorized notary public. The Commonwealth retains the right to request an updated affidavit at any time. No pricing, set-asides, incumbent information, or funding details are contained in this form.
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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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