Attachment B - Annual Affidavit - RFB 758 2700000185.pdf
PDF 120 KB Posted
- Attached to
- KHP NIGHT MUCK REMOVAL, LOADING, AND HAULING
- Solicitation number
- RFB 758 2700000185 2
- Issued by
- Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors and Contractors issued by the Commonwealth of Kentucky for RFB 758 2700000185 related to the KHP Night Muck Removal, Loading, and Hauling contract opportunity in Kentucky. The affidavit form requires an authorized representative of the bidding contractor to complete an attestation, have it notarized, and submit it to the Commonwealth. The affidavit is effective for one year from the date of execution and is required pursuant to Kentucky Revised Statutes (KRS) 45A.110 and 45A.115 for any bidder, offeror, or contractor seeking to be awarded a contract or to renew an existing contract.
The attestation requires the contractor's authorized representative to swear under penalty of perjury that the contractor has not knowingly violated Kentucky's campaign finance laws and that awarding the contract will not violate any provision of those laws. "Knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation. The form requires the contractor's name, address, Commonwealth of Kentucky vendor code if known, the authorized representative's signature, printed name, title, and date, as well as notarization by a notary public including the state, county, notary name, and commission expiration date. 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 .