Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
PDF 150 KB Posted
- Attached to
- RoW Mow ONLY: McCreary Co
- Solicitation number
- RFB 605 2400000436 3
- Issued by
- Madison County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky pursuant to 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 Commonwealth. The affidavit is effective for one year from the date of execution. Bidders and offerors must attest under penalty of perjury 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 such laws. For purposes of this attestation, "knowingly" is defined as awareness or constructive awareness of the existence of a violation.
The Commonwealth retains the right to request an updated affidavit at any time during the contract period. The document requires the contractor's authorized representative to provide signature, printed name, title, date, the bidder or offeror name and address, and the Commonwealth of Kentucky Vendor Code if known. The attestation must be notarized before a notary public, with the notary providing their signature, the date of notarization, state and county of notarization, and 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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