Attachment A - Annual Required Affidavit for Bidders Offerors and Contractors.pdf
PDF 253 KB Posted
- Attached to
- Child Support Genetic Testing
- Solicitation number
- RFP 040 2600000321 1
- Issued by
- Kentucky
About this file
This is an affidavit form required by the Commonwealth of Kentucky pursuant to KRS 45A.110 and 45A.115 for bidders, offerors, and contractors seeking to be awarded state contracts or contract renewals. The affidavit must be completed by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth. The affidavit is effective for one year from the date of execution and may be updated at any time at the Commonwealth's request.
The attestation requires the 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 those laws. For purposes of this attestation, "knowingly" is defined as awareness or reasonable awareness of a violation's existence. The form requires completion of contractor identification information including name, address, and vendor code, along with the representative's signature, printed name, title, and date. Notarization must occur before a notary public who must provide their name, the state and county of notarization, commission expiration date, and signature.
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| File | Type | Posted |
|---|---|---|
| Final_RFP_040_2600000321_1_SO_FORM.PDF |
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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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| Vendor Code: |
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| Notary Name: |
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| Commission Expiration Date: |
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