Attachment D - Annual Affidavit.pdf
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- Solicitation number
- RFP 660 2700000033 1
- Issued by
- Elliott County, Kentucky
About this file
This is a Required Affidavit for Bidders, Offerors, and Contractors issued by the Commonwealth of Kentucky in connection with the KDFWR Professional Aerial Herbicide Application contract opportunity for Franklin County. The affidavit serves as a mandatory compliance document required under Kentucky Revised Statutes 45A.110 and 45A.115 for any entity seeking to be awarded a contract or contract renewal with the state. An authorized representative of the bidding contractor must complete the attestation, obtain notarization, and submit the executed document to the Commonwealth. The affidavit is valid 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 Kentucky campaign finance laws and that contract award will not violate any provision of the state's campaign finance statutes. For purposes of this requirement, "knowingly" is defined as the bidder or offeror being aware or having reason to be aware of a violation's existence. The Commonwealth reserves the right to request an updated affidavit at any time during the contract term. The form requires completion of contractor identification information including name, address, and Kentucky Vendor Code if available, along with notarization by a qualified notary public.
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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 .