Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
PDF 150 KB Posted
- Attached to
- PEST CONTROL - DISTRICT 10
- Solicitation number
- RFB 605 2500000043 2
- Issued by
- Breckinridge County, Kentucky
About this file
This is an Annual Affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking contract awards or contract renewals. The form is effective for one year from the date of execution and is mandated under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. An authorized representative of the contracting party must complete the attestation, have it notarized, and submit it to the Commonwealth. The affidavit serves as a prerequisite to contract award or renewal and does not involve specific products, services, quantities, response dates, or site visits.
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 awarding the contract will not violate any campaign finance law provisions. "Knowingly" is defined as awareness or reasonable awareness of a violation's existence. The form requires the contractor's name, address, and Commonwealth vendor code, along with the signature, printed name, title, and date of the authorized representative. A notary public must witness and notarize the attestation, including their state, county, signature, and commission expiration date. The Commonwealth retains the right to request an updated affidavit at any time during the contract term.
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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: _____________________ https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22348 https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=22349
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