Attach D-Qualified Bidder Affidavit.doc
DOC document 35 KB Posted
- Attached to
- GOLF COURSE CHEMICALS
- Solicitation number
- RFB 758 2100000184 1
- Issued by
- Kentucky
About this file
This is a Qualified Bidder Affidavit document for Solicitation/Contract #RFB 758 2100000184, administered by a state agency operating under Kentucky statutes. The affidavit requires bidders and offerors claiming qualified bidder status to swear under penalty of perjury that they and all subcontractors meet the requirements established in 200 KAR 5:410(3) and will maintain compliance throughout the contract duration. Bidders must identify the specific qualified bidder status being claimed, with options including nonprofit corporations furthering the purposes of KRS Chapter 163 or qualified nonprofit agencies for individuals with severe disabilities as defined under KRS 45A.465(3).
A qualified nonprofit agency for individuals with severe disabilities must be organized and operated in the interest of such individuals, comply with applicable occupational health and safety laws of the United States and Kentucky, employ individuals with severe disabilities for not less than 75 percent of the man hours of direct labor in manufacturing or providing products or services listed under KRS 45A.470, and be registered and in good standing as a nonprofit organization with the Secretary of State. The bidding agency reserves the right to request documentation supporting any qualified bidder status claim, and failure to provide such documentation upon request may result in bidder disqualification or contract termination. All affidavits must be notarized and signed by an authorized representative of the bidding entity.
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Text version
Solicitation/Contract #: RFB 758 2100000184 REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING QUALIFIED BIDDER STATUS
FOR BIDS AND CONTRACTS IN GENERAL:
I. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, and all subcontractors therein, meets the requirements to be considered a “qualified bidder” in accordance with 200 KAR 5:410(3); and will continue to comply with such requirements for the duration of any contract awarded. Please identify below the particular “qualified bidder” status claimed by the bidding entity.
________ A nonprofit corporation that furthers the purposes of KRS Chapter 163 _______ Per KRS 45A.465(3), a "Qualified nonprofit agency for individuals with severe disabilities" means an organization that:
(a) Is organized and operated in the interest of individuals with severe disabilities; and
(b) Complies with any applicable occupational health and safety law of the United States and the Commonwealth; and
(c) In the manufacture or provision of products or services listed or purchased under KRS 45A.470, during the fiscal year employs individuals with severe disabilities for not less than seventy-five percent (75%) of the man hours of direct labor required for the manufacture or provision of the products or services; and
(d) Is registered and in good standing as a nonprofit organization with the Secretary of State.
The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of qualified bidder status. Failure to provide such documentation upon request may 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:
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