Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Attached to
- RoW Mowing (ONLY) Adair/Cumberland Co
- Solicitation number
- RFB 605 2400000430 2
- Issued by
- Adair County, Kentucky
About this file
This is an Annual Affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded contracts or contract renewals under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit serves as a mandatory attestation document that must be completed, notarized, and submitted to the Commonwealth prior to contract award. The affidavit remains effective for one year from the date of execution.
An authorized representative of the contracting party must complete the attestation by swearing and affirming under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that the contract award will not violate any provision of those laws. The term "knowingly" is defined as awareness or reasonably should have been aware of a violation's existence. The form requires the bidder or offeror to provide company name, address, and Commonwealth of Kentucky vendor code if known, along with the authorized representative's signature, printed name, title, and date. The completed affidavit must be notarized, with the notary providing their signature, commission expiration date, state, and county. The Commonwealth reserves the right to request an updated affidavit at any time during the contract period.
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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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