Attachment B Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Solicitation number
- RFB 758 2700000060 2
- Issued by
- Kentucky
About this file
This is an Annual Affidavit document for the Kentucky state contract opportunity for WSH (Western State Hospital) and Nursing Facility Laundry and Linen Service. The affidavit serves as a compliance and attestation document required from bidders and contractors participating in this laundry and linen service procurement. The document establishes the formal declarations and certifications that bidders must submit annually to maintain eligibility and compliance with state requirements throughout the contract period.
The affidavit contains standard attestations regarding the contractor's business practices, legal standing, and adherence to state regulations. It requires contractors to affirm information related to their operational status, compliance with applicable laws, and ability to perform the required laundry and linen services for the designated healthcare facilities. This annual submission requirement ensures ongoing verification of contractor qualifications and maintains accountability throughout the contract term, with the document serving as a binding commitment to the representations made by the bidding or incumbent contractor.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C Vendors' Question Form.xlsx | XLSX spreadsheet | |
| Final_RFB_758_2700000060_1_SO_FORM.PDF | ||
| Final_RFB_758_2700000060_2_SO_FORM.PDF | ||
| Attachment D Addendum 1.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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