Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
PDF 150 KB Posted
- Attached to
- Used Railroad Rail D9
- Solicitation number
- RFB 605 2400000576 2
- Issued by
- Knott County, Kentucky
About this file
This is a Required Affidavit form for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit is mandatory for any bidder, offeror, or contractor seeking to be awarded a contract or seeking renewal of an existing contract with the Commonwealth. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The affidavit remains effective for one year from the date of execution.
Under this attestation, the authorized representative must 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 provision of the state's campaign finance laws. For this purpose, "knowingly" is defined as awareness or reasonable awareness of a violation's existence. The Commonwealth reserves the right to request an updated affidavit at any time. The form requires the contractor's signature, printed name, title, date, vendor code if available, and notarization by a qualified notary public with the notary's commission expiration date.
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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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