Attachment C Annual Affidavit and Other Affidavit(s).pdf
PDF 157 KB Posted
- Solicitation number
- RFP 758 2600000435 2
- Issued by
- Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors, and Contractors document issued by the Commonwealth of Kentucky pursuant to KRS 45A.110 and 45A.115, applicable to the Kentucky Cigarette Tax Stamps, Fulfillment and Distribution contract opportunity. The affidavit is effective for one year from the date of execution and must be completed by an authorized representative of the contracting party, notarized, and submitted to the Commonwealth prior to contract award or contract renewal. The document requires the contractor to attest 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 Kentucky's campaign finance laws. For purposes of this attestation, "knowingly" is defined as the bidder or offeror being aware or should have been aware of the existence of a violation.
The affidavit form requires completion of standard identifying information including the bidder or offeror name, address, Commonwealth of Kentucky Vendor Code if known, authorized representative signature, printed name, title, and date. The completed attestation must be notarized, with the notary providing their signature, commission expiration date, and identifying information regarding the state and county where the notarization occurs. The Commonwealth retains the right to request an updated affidavit at any time during the contract term.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment B - Cost Proposal Form V2.docx | DOCX document | |
| Final_RFP_758_2600000435_1_SO_FORM.PDF | ||
| Attachment D - Vendors' Question Form.xlsx | XLSX spreadsheet | |
| Final_RFP_758_2600000435_2_SO_FORM.PDF |
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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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