Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.docx
DOCX document 111 KB Posted
- Attached to
- Count Station Maintenance REBID
- Solicitation number
- RFB 605 2300000780 2
- 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 affidavit serves as a certification that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of those laws. The affidavit is effective for one year from the date of execution, though the Commonwealth retains the right to request updated affidavits at any time during this period.
The affidavit form requires the contractor to provide basic identifying information including the bidder or offeror name, address, and Commonwealth vendor code if available. An authorized representative must sign the attestation under penalty of perjury and have the signature notarized by a notary public, including the notary's commission expiration date. For purposes of the attestation, "knowingly" is defined as awareness or reasonable awareness of a violation's existence. The completed and notarized affidavit must be returned to the Commonwealth as a condition of contract award or renewal.
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Other files
| File | Type | Posted |
|---|---|---|
| How to Submit an Online Response - March 2023.pdf | ||
| Final_RFB_605_2300000780_1_SO_FORM.PDF | ||
| District Map.pdf | ||
| Bid Sheets Group 1.pdf | ||
| Bid Sheet Group 2.pdf | ||
| Bid Sheets Group 3.pdf | ||
| Bid Sheets Group 4.pdf | ||
| FHWA-1273.pdf | ||
| Drawings.pdf | ||
| Final_RFB_605_2300000780_2_SO_FORM.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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