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 form for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit applies to RFB 758 2600000247 and serves as a mandatory submission requirement for any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the state. The authorized representative of the contracting party must complete the attestation, obtain notarization, and return the executed document to the Commonwealth. The affidavit remains effective for one year from the date of execution.
The affidavit 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 the contract award will not violate any provision of the state's campaign finance laws. "Knowingly" is defined as awareness or should-have-been awareness of a violation's existence. The form must include the bidder or offeror's name, address, Commonwealth of Kentucky vendor code if known, notarization details including the notary signature and commission expiration date, and the signature, printed name, title, and date of the authorized representative. 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 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 .