Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Attached to
- Eq Rental Offset Drill D-10 w-op -STATE
- Solicitation number
- RFB 605 2400000738 3
- Issued by
- Kentucky
About this file
This document is a required affidavit form established by the Commonwealth of Kentucky under statutes KRS 45A.110 and 45A.115 that must be submitted by bidders, offerors, and contractors seeking to be awarded or renew state contracts. The affidavit serves as a one-year certification and requires an authorized representative of the contracting party to attest 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. The form must be notarized and returned to the Commonwealth prior to contract award or renewal.
The attestation defines "knowingly" as awareness or constructive awareness of a violation's existence. The Commonwealth retains the right to request an updated affidavit at any time during the contract term. The completed form requires the contractor's signature, printed name, title, and execution date, along with the bidder or offeror's legal name, address, and Kentucky Vendor Code if available. Notarization must occur before a notary public who must provide their signature, commission expiration date, and identify the state and county where the oath was administered.
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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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