ATTTACHMENT A - Annual Affidavit for Bidders, Offerors and Contractors - Jan 2023.pdf
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- Solicitation number
- RFP 605 2600000172 2
- Issued by
- Kentucky
About this file
This is an Annual Affidavit for Bidders, Offerors and Contractors required by the Commonwealth of Kentucky under KRS 45A.110 and 45A.115. The affidavit is effective for one year from the date of execution and must be submitted by any bidder, offeror, or contractor seeking to be awarded a contract or contract renewal with the state. An authorized representative of the contracting party must complete the attestation, obtain notarization, and return the completed affidavit to the Commonwealth. The form requires the bidder or offeror to provide organizational identification information, including name, address, and Commonwealth vendor code if known.
The primary requirement of this affidavit is that the contractor swear and affirm under penalty of perjury that the organization 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 the attestation, "knowingly" is defined as awareness or should-have-been awareness of a violation's existence. The Commonwealth retains the right to request updated affidavits 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: _____________________ 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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