Attachment B Annual Affidavit and Other Affidavit(s).pdf
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- Attached to
- Courier Service for Newborn Screening Samples
- Solicitation number
- RFB 758 2600000675 4
- Issued by
- Kentucky
About this file
This is an annual affidavit attachment document for the Commonwealth of Kentucky related to a courier service contract for newborn screening samples. The affidavit serves as a compliance and certification document that bidders must complete and submit as part of their proposal response. The document establishes the framework for annual certifications and declarations required from vendors seeking to perform courier services for the state's newborn screening program. Bidders are required to affirm their eligibility, legal status, and compliance with state and federal requirements through the completion of specified affidavits before contract award.
The affidavit attachment establishes mandatory certifications regarding vendor qualifications, including attestations related to business legitimacy, regulatory compliance, and adherence to state and federal laws. Vendors must provide annual reaffirmations of their certifications throughout any contract period, with renewal options requiring updated affidavits to maintain contract status. The document specifies which affidavits are required, the frequency of submission, and the legal consequences of providing false or incomplete information. This attachment is a standard pre-award requirement designed to ensure vendor accountability and regulatory compliance for the duration of the courier service contract with the Kentucky state health department or designated agency administering the newborn screening program.
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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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