Attachment B Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Solicitation number
- RFB 758 2700000060 3
- Issued by
- Clinton County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors document issued by the Commonwealth of Kentucky pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit applies to the WSH and Nursing Facility Laundry and Linen Service contract opportunity in Kentucky. The document requires an authorized representative of any bidder, offeror, or contractor to complete an attestation, have it notarized, and submit it to the Commonwealth. The affidavit is effective for one year from the date of execution. Bidders must attest under penalty of perjury that their organization has not knowingly violated Kentucky campaign finance laws and that awarding the contract will not violate any provision of state campaign finance laws.
The affidavit requires the contracting party to provide the bidder or offeror name, address, and Commonwealth of Kentucky Vendor Code if known. The authorized representative must sign and date the attestation, which must be notarized before a notary public who will also sign and provide their commission expiration date. The Commonwealth retains the right to request an updated affidavit at any time during the contract term. For purposes of the attestation, "knowingly" is defined as awareness or should-have-been awareness of a violation. This affidavit is a mandatory compliance requirement for contract award and renewal eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_758_2700000060_1_SO_FORM.PDF | ||
| Attachment D Addendum 1.pdf | ||
| Attachment D Addendum 2.pdf | ||
| Final_RFB_758_2700000060_3_SO_FORM.PDF | ||
| Final_RFB_758_2700000060_2_SO_FORM.PDF | ||
| Attachment C Vendors' Question Form.xlsx | XLSX spreadsheet |
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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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