Attachment B Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Attached to
- Mobile Air Quality Monitoring Equipment Shelter
- Solicitation number
- RFB 758 2700000113 1
- Issued by
- Kentucky
About this file
This is a Required Affidavit form for Bidders, Offerors, and Contractors mandated by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115, applicable to the Mobile Air Quality Monitoring Equipment Shelter contract opportunity in Kentucky. The affidavit must be completed by an authorized representative of the contracting party and notarized before submission to the Commonwealth. The attestation confirms that the contractor has not knowingly violated Kentucky campaign finance laws and that contract award will not violate any provision of state campaign finance laws. The affidavit is effective for one year from the date of execution, and the Commonwealth retains the right to request updated affidavits at any time during the contract period.
The form requires the contractor to provide basic information including bidder or offeror name, address, and Commonwealth of Kentucky vendor code if known. An authorized representative must sign the attestation under penalty of perjury, and the document must be notarized with the notary's signature, commission expiration date, state, and county information recorded. The term "knowingly" is defined to mean the bidder or offeror is aware or should have been aware of any violation of campaign finance laws. This affidavit requirement applies to all bidders and offerors seeking to be awarded contracts or contract renewals with the Commonwealth of Kentucky.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C Vendors' Question Form.xlsx | XLSX spreadsheet | |
| Final_RFB_758_2700000113_1_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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