ATTACHMENT A - Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
PDF 150 KB Posted
- Attached to
- ENGINEERING TRAINING FY 27-28
- Solicitation number
- RFP-605-2600000097-3
- Issued by
- Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors mandated by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115, applicable to the Engineering Training FY 27-28 contract opportunity in Kentucky. The affidavit serves as a certification document that must be completed, notarized, and submitted by an authorized representative of any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the state. The affidavit is effective for one year from the date of execution and requires the authorized representative to attest under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not violate any provision of such laws.
The affidavit form requires the contractor to provide basic identifying information including the bidder or offeror name, address, and Commonwealth of Kentucky vendor code if known. An authorized representative must sign the attestation, provide their printed name and title, and include the date of execution. The completed form must then be subscribed and sworn before a notary public, who must document the state and county where notarization occurs, the date of notarization, and the expiration date of their commission. 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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