Attachment B Annual Affidavit and Other Affidavit(s).pdf
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- Solicitation number
- RFB 758 2700000003 1
- Issued by
- Kentucky
About this file
This is an affidavit document required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking contract awards or contract renewals. The affidavit applies to the Fumigation Chemicals and Materials for Tree Nurseries contract opportunity in Kentucky and is effective for one year from the date of execution. An authorized representative of the bidder or offeror must complete the attestation, have it notarized, and submit it to the Commonwealth. The document requires the authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that the contract award will not violate any provision of the state's campaign finance laws.
The affidavit form includes fields for the bidder or offeror to provide their name, address, and Commonwealth of Kentucky vendor code, along with signature, printed name, title, and date of execution by the authorized representative. Notarization is mandatory, requiring the notary's signature, the state and county where the oath is administered, and the notary's commission expiration date. For purposes of this attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation. The Commonwealth retains the right to request an updated affidavit at any time. This required affidavit is mandated under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C Vendors' Question Form.xlsx | XLSX spreadsheet | |
| Final_RFB_758_2700000003_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 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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