Attach C Resident Bidder Affidavit.doc
DOC document 35 KB Posted
- Attached to
- ADVANCED LIFE SUPPORT AMBULANCE SERVICES
- Solicitation number
- RFB 758 2000000375 1
- Issued by
- Jefferson County, Kentucky
About this file
This is a Required Affidavit for Resident Bidder Status document associated with RFB 758 2000000375, issued by an unspecified bidding agency in Kentucky. The affidavit establishes the requirements and certification process for bidders seeking resident bidder status under Kentucky Revised Statutes (KRS) 45A.494(2). Bidders must affirm under penalty of perjury that their entity is authorized to transact business in the Commonwealth and has maintained compliance with three specific requirements for one year prior to and through the date of contract advertisement: filing Kentucky income taxes, making payments to the Kentucky unemployment insurance fund, and maintaining an active Kentucky workers' compensation policy.
The bidding agency reserves the right to request documentation substantiating a bidder's claim of resident bidder status, and failure to provide such documentation upon request will result in bidder disqualification or contract termination. The affidavit requires the signature and printed name of an authorized representative, their title, the date of execution, and company name and address. The document must be notarized, with the notary public providing their seal and commission expiration date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Detailed Requirements-Ambulance Service.docx | DOCX document | |
| Attach B ANNUAL AFFIDAVIT.pdf | ||
| Final_RFB_758_2000000375_1_SO_FORM.PDF | ||
| Attach D Qualified Bidder Affidavit.doc | DOC document | |
| Attach A 758 2000000375.pdf |
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Text version
Solicitation/Contract #: RFB 758 2000000375 REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING RESIDENT BIDDER STATUS
FOR BIDS AND CONTRACTS IN GENERAL:
The bidder or offeror hereby swears and affirms under penalty of perjury that, in accordance with KRS 45A.494(2), the entity bidding is an individual, partnership, association, corporation, or other business entity that, on the date the contract is first advertised or announced as available for bidding:
1. Is authorized to transact business in the Commonwealth;
2. Has for one year prior to and through the date of advertisement
a. Filed Kentucky income taxes;
b. Made payments to the Kentucky unemployment insurance fund established in KRS 341.49; and
c. Maintained a Kentucky workers’ compensation policy in effect.
The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of resident bidder status. Failure to provide such documentation upon request shall result in disqualification of the bidder or contract termination.
Signature
Printed Name
Title
Date
Company Name
Address
Subscribed and sworn to before me by
(Affiant)
(Title) of this _____day of ____________,20___.
(Company Name)
Notary Public
[seal of notary]
My commission expires:
File details come from the government source that posted it. Updated .