Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Attached to
- Eq Rental Offset Drill D-10 w-op-FHWA
- Solicitation number
- RFB 605 2400000781 3
- Issued by
- Kentucky
About this file
This is a required affidavit form issued by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded or renew a state contract. The affidavit is effective for one year from the date of execution and must be completed by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth in accordance with Kentucky Revised Statutes 45A.110 and 45A.115. The form requires attestation that the contractor has not knowingly violated campaign finance laws of Kentucky and that contract award will not violate any provision of such laws. The affidavit includes fields for the contractor's signature, printed name, title, date of execution, bidder or offeror name and address, Commonwealth of Kentucky vendor code if known, and notarization information including the notary's signature, commission expiration date, and state and county of notarization.
The affidavit applies to all bidders and offerors regardless of contract value or type. "Knowingly" is defined to mean that the bidder or offeror is aware or should have been aware of the existence of a violation. The Commonwealth retains the right to request an updated affidavit at any time during the contract period or renewal process. No pricing, set-asides, or other financial terms are addressed in this procedural document, as it serves solely as a compliance certification mechanism for campaign finance law adherence.
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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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