Attachment C - Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Attached to
- Chemical Analysis Testing Services
- Solicitation number
- RFB 758 2600000540 1
- Issued by
- Kentucky
About this file
This is an affidavit form required by the Commonwealth of Kentucky for bidders, offerors, and contractors seeking to be awarded or renew contracts under Kentucky Revised Statutes (KRS) 45A.110 and 45A.115. The affidavit applies to Chemical Analysis Testing Services being procured by the state of Kentucky. The form requires an authorized representative of the contracting party to attest under penalty of perjury that the contractor has not knowingly violated Kentucky campaign finance laws and that the contract award will not violate any provision of state campaign finance laws. The affidavit remains effective for one year from the date of execution.
The attestation must be completed, notarized, and returned to the Commonwealth of Kentucky. An authorized representative must provide their signature, printed name, title, and date, along with the bidder or offeror's name, address, and Kentucky vendor code if available. The notary acknowledgment section requires the date, state, county, and the notary's name and commission expiration date. The Commonwealth reserves the right to request an updated affidavit at any time during the contract period.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment B - Bid Sheet.xlsx | XLSX spreadsheet | |
| Final_RFB_758_2600000540_1_SO_FORM.PDF | ||
| Attachment D - 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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