Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Solicitation number
- RFB 605 2300000450 2
- Issued by
- Madison County, Kentucky
About this file
This is an Annual Affidavit for Bidders, Offerors and Contractors required by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit is a mandatory document that must be completed and submitted by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or requesting contract renewal with the Commonwealth. The affidavit is effective for one year from the date of execution and must be notarized before submission to the Commonwealth.
The affidavit requires the authorized representative to attest 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 these laws. "Knowingly" is defined as awareness or reasonable awareness of a violation's existence. The form requires the bidder or offeror to provide their name, address, and Kentucky Vendor Code (if known), and must be signed and dated by an authorized representative before a notary public, who must also complete their notarization information including the date and commission expiration. The Commonwealth retains 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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