Attachment B Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Attached to
- Sodium Chloride Type 1 Grade 1 Road Salt
- Solicitation number
- RFB 758 2700000206 1
- Issued by
- Kentucky
About this file
This document is a Required Affidavit for Bidders, Offerors, and Contractors established under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115, applicable to the Commonwealth of Kentucky's Sodium Chloride Type 1 Grade 1 Road Salt contract opportunity. The affidavit is effective for one year from the date of execution and must be completed, notarized, and submitted by an authorized representative of the contracting party to be eligible for contract award or renewal. The attestation requires the contractor to swear under penalty of perjury that it has not knowingly violated Kentucky's campaign finance laws and that the contract award will not violate any provision of these laws. The term "knowingly" is defined as awareness or should-be awareness of a violation's existence.
The Commonwealth of Kentucky retains the right to request an updated affidavit at any time during the contract period. The form requires standard contractor information including name, address, and vendor code, along with the signature, printed name, and title of the authorized representative, which must be notarized with the notary's signature, commission expiration date, and the state and county where notarization occurs. No pricing terms, set-asides, incumbents, or other financial requirements are specified in this affidavit document, as it serves solely as a compliance and integrity certification requirement for contract participation.
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Other files
| File | Type | Posted |
|---|---|---|
| Final_RFB_758_2700000206_1_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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