Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Attached to
- Janitorial Services for Pikeville Real ID Office
- Solicitation number
- RFB 605 2400000743 2
- Issued by
- Breckinridge County, Kentucky
About this file
This is a required affidavit form for bidders, offerors, and contractors issued by the Commonwealth of Kentucky pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit must be submitted by any contractor seeking to be awarded a contract or renew an existing contract with the state. An authorized representative of the contracting party is required to complete the attestation, obtain notarization, and return the completed form to the Commonwealth. The affidavit is effective for one year from the date of execution and must be resubmitted upon contract renewal or at any time the Commonwealth requests an updated version.
The affidavit requires the contractor's authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of state campaign finance laws. For purposes of this attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation. The form requires completion of contractor identification information including name, address, and Commonwealth of Kentucky vendor code if known, along with the notary's certification including the state, county, notary name, 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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