Attachment A - Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Loop Detectors-FHWA Eligible
- Solicitation number
- RFB 605 2500000057 1
- Issued by
- Kentucky
About this file
This is an affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking contract awards or contract renewals under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit applies 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 prior to contract award. The form requires attestation that the contractor has not knowingly violated Kentucky campaign finance laws and that the contract award will not violate any provision of the Commonwealth's campaign finance laws. "Knowingly" is defined as awareness or reasonable awareness of a violation's existence.
The affidavit requires submission of bidder or offeror information including company name, address, and Commonwealth vendor code if known. An authorized representative must provide signature, printed name, title, and date, along with notarization including the notary's signature, state and county of notarization, commission expiration date, and the specific date of notarization. The Commonwealth retains the right to request updated affidavits at any time during the contract period. This document serves as a compliance mechanism to ensure contractor eligibility and adherence to Kentucky's campaign finance regulations.
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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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