ATTACHMENT B - Annual Affidavit - RFB 758 2600000247.pdf
PDF 120 KB Posted
- Attached to
- KREC Errors & Omissions Insurance Policy
- Solicitation number
- RFB-758-2600000247-2
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors, and Contractors document issued by the Commonwealth of Kentucky for RFB 758 2600000247 related to a KREC Errors & Omissions Insurance Policy procurement. The affidavit serves as a mandatory compliance document that must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or pursue contract renewal with the Commonwealth of Kentucky. The document requires an authorized representative of the contracting party to complete an 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 under penalty of perjury that the contractor has not knowingly violated campaign finance laws of the Commonwealth of Kentucky and that the contract award will not violate any provision of Kentucky's campaign finance laws. "Knowingly" is defined as the bidder or offeror being aware or should have been aware of a violation's existence. The Commonwealth retains the right to request an updated affidavit at any time. The form requires completion of contractor identification information including name, address, and vendor code, along with notarization by a notary public, including the notary's commission expiration date and state and county information.
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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 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: _____________________
File details come from the government source that posted it. Updated .