Attachment B Annual Affidavit and Other Affidavit(s).pdf
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- Solicitation number
- RFB 758 2700000060 5
- Issued by
- Clark County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors, and Contractors document issued by the Commonwealth of Kentucky in compliance with KRS 45A.110 and 45A.115 for the WSH and Nursing Facility Laundry and Linen Service contract opportunity. The affidavit is a mandatory submission requirement for any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the state. An authorized representative of the contracting party must complete the attestation, obtain notarization, and return the completed form to the Commonwealth. The affidavit is effective for one year from the date of execution.
The attestation requires the authorized representative to swear and affirm under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that contract award will not violate any campaign finance law provisions. For purposes of this attestation, "knowingly" is defined as awareness or should-have-been awareness of a violation's existence. The affidavit form requires contractor identification information including name, address, and Commonwealth vendor code, along with signature, printed name, title, and date from the authorized representative. The document must be notarized with the notary's signature, commission expiration date, and state and county information. The Commonwealth retains the right to request an updated affidavit at any time during the contract period.
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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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