Attachment B Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Attached to
- Courier Service for Newborn Screening Samples
- Solicitation number
- RFB 758 2600000675 3
- Issued by
- Kentucky
About this file
This is a Required Affidavit form for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky pursuant to KRS 45A.110 and 45A.115, applicable to the Courier Service for Newborn Screening Samples contract opportunity. The affidavit serves as a mandatory submission requirement for any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the Commonwealth. An authorized representative of the contracting party must complete the attestation, obtain notarization, and submit the completed affidavit to the Commonwealth. The affidavit is effective for one year from the date of execution.
The affidavit requires the contractor's 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 such laws. For purposes of the attestation, "knowingly" is defined as the bidder or offeror being aware or having reason to be aware of a violation's existence. The Commonwealth reserves the right to request an updated affidavit at any time during the contract period. The form requires the contractor to provide signature, printed name, title, date, bidder or offeror name, complete address, and Commonwealth of Kentucky Vendor Code if available, followed by notarization with the notary's signature, commission expiration date, and the state and county where the oath is administered.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_758_2600000675_2_SO_FORM.PDF | ||
| Attachment D Location Information.pdf | ||
| Attachment E Addendum 2.pdf | ||
| Attachment C Vendors' Question Form.xlsx | XLSX spreadsheet | |
| Attachment D Addendum 1.pdf | ||
| Final_RFB_758_2600000675_1_SO_FORM.PDF | ||
| Final_RFB_758_2600000675_3_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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