Final_RFQ_540_2300000049_2_SO_FORM.PDF

Document ID: RFQ 540 2300000049 Page: 1

Commonwealth of Kentucky

SOLICITATION MODIFICATION

Modification: Yes Version #: 2

TITLE: Letcher Co AR8 ProV5 CNC Machine Including Attachments

Date Issued:

09/13/2022 Record Date:

09/13/2022

Solicitation Closes Date:

09/26/2022 Time:

14:30

Solicitation No:

RFQ 540 2300000049

Reason for Modification

Addendum #1 9/13/2022 - Added additional commodity lines for AR* ProV5 CNC Machine for attachments

Online Bidding Prohibited: Yes For Information Call:

Tracey Huckeba 502-564-1979

Bid Receiving Location:

Bid Receiving

See Terms & Conditions for Bid Submission Instructions

Other KY

Vendor Customer Number:

Vendor Name:

Phone Number:

Fax Number:

Email Address:

Ordering

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Payment

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Ownership Type

__ Sole Proprietorship __ Partnership __ Corporation __ Other_________________________

SIGNATURE OF AUTHORIZED AGENT IS REQUIRED UNLESS RESPONSE

IS SUBMITTED ELECTRONICALLY. FAILURE TO SIGN SHALL RENDER

THE BID INVALID.

Signature X_________________________________________ FEIN#____________________ Date____________

All offers subject to all terms and conditions contained in this solicitation.

Document ID: RFQ 540 2300000049 Page: 2

Line Items

Commodity Group: Default

Line CL Description Quantity UOM Unit Cost Line Total or Contract Amnt

1 AR8 ProV5 CNC Machine Including Attachments

1.00000 EA

Comm Code Comm Description Manufacturer Model # Manuf Part #

545 MACHINERY AND HARDWARE,

INDUSTRIAL

Extended Description AR8 ProV5 CNC Machine Including Attachments

2 Axiom Stand 8 1.00000 EA

Axiom Stand 8

3 Axiom Tool Box 1.00000 EA

Axiom Tool Box

4 Axiom Pendant Protector 1.00000 EA

Axiom Pendant Protector

Document ID: RFQ 540 2300000049 Page: 3

5 Axiom Dustshoe Pro/Elite 1.00000 EA

Axiom Dustshoe Pro/Elite

6 Axiom Hold Down Clamp - Pair 5.00000 EA

Axiom Hold Down Clamp - Pair

7 Axiom Overarm Dust Accessory 1.00000 EA

Axiom Overarm Dust Accessory

8 Amana 9 PC CNC Bit Set 2.00000 EA

Amana 9 PC CNC Bit Set

Document ID: RFQ 540 2300000049 Page: 4

9 Amana 3PC Starter Bit Set 1.00000 EA

Amana 3PC Starter Bit Set

10 Amana 2 PC Carving Bit Set 1.00000 EA

Amana 2 PC Carving Bit Set

11 Amana 3PC Inlay Bit Set 1.00000 EA

Amana 3PC Inlay Bit Set

12 Vectric VCarve Pro Software 1.00000 EA

Vectric VCarve Pro Software

Shipping Information Area Technology Center - Letcher County

Billing Information Area Technology Center - Letcher County

Document ID: RFQ 540 2300000049 Page: 5

Shipping 515 Cougar Dr

Whitesburg KY 41858

Billing 515 Cougar Dr

Whitesburg KY 41858

Document ID: RFQ 540 2300000049 Page: 6

Submission Checklist

The following items will be required to be submitted with bid:

Item Price (90 Points) Warranty (5 Points) Delivery (5 Points)

Addendum #1 9/13/2022 – Added additional commodity lines for AR* ProV5 CNC Machine for attachments

Kentucky Department of Education

300 Sower Boulevard Frankfort, KY 40601

Informal Solicitation for Goods or Non-Professional Service

Please note: The Finance and Administration Cabinet Policy Procedure FAP 110-10-00: General Conditions and Instructions for Solicitations and Contracts is hereby incorporated by reference into this solicitation.

The Web site for entire Policies and Procedure manual: http://finance.ky.gov/services/policies/Pages/ default.aspx

Solicitation Instructions Due Date for Response 2:30 PM EST September 26, 2022

Request for Quotation must be returned to the following Tracey Huckeba KY Department of Education Division of Budgets & Financial Management 300 Sower Blvd Frankfort KY, 40601 Tracey.Huckeba@education.ky.gov

Only Emailed quotes will be condsidered due to COVID 19 Heathy at Work Guidlines

Terms and Conditions

DELIVERY LOCATION

Letcher Co ATC 515 Cougar Dr.

Whitesburg KY 41858 Dejah Newsome, Principal Kitty Back, Administrative Specialist

(606) 633-5053

DELIVERY/INSTALLATION COMPLETION DATE

Delivery is required before November 15, 2022

Pricing should include all shipping/delivery and installation and training costs.

GOODS/SERVICE TO BE PROVIDED BY VENDOR

Quantity 1 - AR8 ProV5 CNC Machine Including Attachments

Quantity 1 - Axiom Stand 8

Quantity 1 - Axiom Tool Box

Quantity 1 - Axiom Pendant Protector

Quantity 1 - Axiom Dustshoe Pro/Elite

Document Description Page 7

2300000049 Letcher Co AR8 ProV5 CNC Machine Including Attachments http://finance.ky.gov/services/policies/Pages/default.aspx http://finance.ky.gov/services/policies/Pages/default.aspx

Quantity 5 - Axiom Hold Down Clamp – Pair

Quantity 1 – Axiom Overarm Dust Accessory

Quantity 2 – Amana 9 PC CNC Bit Set

Quantity 1 – Amana 3PC Starter Bit Set

Quantity 1 – Amana 2 PC Carving Bit Set

Quantity 1 – Amana 3PC Inlay Bit Set

Quantity 1 – Vectric VCarve Pro Software

SPECIFICATIONS

Quantity 1 - AR8 ProV5 CNC Machine Including Attachments

Quantity 1 - Axiom Stand 8

Quantity 1 - Axiom Tool Box

Quantity 1 - Axiom Pendant Protector

Quantity 1 - Axiom Dustshoe Pro/Elite

Quantity 5 - Axiom Hold Down Clamp – Pair

Quantity 1 – Axiom Overarm Dust Accessory

Quantity 2 – Amana 9 PC CNC Bit Set

Quantity 1 – Amana 3PC Starter Bit Set

Quantity 1 – Amana 2 PC Carving Bit Set

Quantity 1 – Amana 3PC Inlay Bit Set

Quantity 1 – Vectric VCarve Pro Software

Onsite Training Any necessary onsite training and certification required for operation.

Quantity 1 - AR8 ProV5 CNC Machine Including Attachments Cost $_______________

Quantity 1 - Axiom Stand 8 Cost $_______________

Document Description Page 8

Quantity 1 - Axiom Tool Box Cost $_______________

Quantity 1 - Axiom Pendant Protector Cost $_______________

Quantity 1 - Axiom Dustshoe Pro/Elite Cost $_______________

Quantity 5 - Axiom Hold Down Clamp – Pair Cost $_______________

Quantity 1 – Axiom Overarm Dust Accessory Cost $_______________

Quantity 2 – Amana 9 PC CNC Bit Set Cost $_______________

Quantity 1 – Amana 3PC Starter Bit Set Cost $_______________

Quantity 1 – Amana 2 PC Carving Bit Set Cost $_______________

Quantity 1 – Amana 3PC Inlay Bit Set Cost $_______________

Quantity 1 – Vectric VCarve Pro Software Cost $_______________

Training Cost $_______________

Peripherals Cost $_______________

Shipping/Handling Cost $_______________

TOTAL COST, including shipping/handling $_______________

WARRANTY

Minimum One-year warranty on all parts and labor. The warranty is attached.

EXCEPTIONS TO SPECIFICAITONS

Vendors are cautioned that changes made to the solicitation other than in the designated fields for response shall render the response invalid and result in a non-responsive bid. Otherwise, it will be considered that items/services offered are in strict compliance with these specifications, and the successful bidder shall be held responsible for delivering materials/services that meet these specifications. Any exceptions shall be marked as such within the body of the bid and explained on a separate page. The Commonwealth is not bound to accept any exceptions.

ALTERNATE BRANDS/SPECIFICATIONS

Unless otherwise specified, brands and specifications referenced in this solicitation are meant to establish a minimum standard of quality only. Bidders may bid brands/specifications they consider to be equal by specifying the brand(s)/specifications and inserting the brand name(s), model number(s), etc. on which they are bidding. Bids offering “equal” products/specifications will be considered for award if such products

Document Description Page 9 are clearly identified in the bid and are determined by the State to meet or exceed fully the minimum essential specifications and salient characteristics referenced in the Solicitation. Bids that contain products/ specifications that fail to meet the minimum essential requirements shall be deemed non-responsive.

Bidders who propose alternate brands/specifications should enclose descriptive literature with their bids so that the equality can be verified. Failure to enclose sufficient literature may result in a non-responsive bid.

If the brands are not changed, the contract will be written accordingly, and the successful bidder shall be required to deliver the brands/specifications stated in the solicitation.

RECYCLE REQUIREMENTS

Prospective bidders are required to comply with Recycle Requirements for the purchase of goods, supplies, equipment, materials and printing with a minimum recycled content to the extent practicable per 200 KAR 5:330. This regulation can be viewed on the Internet at <http://www.lrc.state.ky.us/kar/200/005/330.htm>.

INVOICING INSTRUCTIONS

The vendor is responsible to submit an invoice to the agency at the address indicated above on or before the 10th of the month following the month in which the service(s) were rendered. Invoices shall contain, at a minimum, the following information: Contract and order number (if any), item numbers, description of supplies or services, sizes, quantities, unit prices, and extended totals.

PAYMENT TERMS

The Commonwealth shall pay all invoices in accordance with KRS 44.010, KRS 45.453 and KRS 45.454, which basically is “when due, and within 30 working days after receipt of approved invoice.” Vendor/ Contractor/Proprietor with the ability to accept credit card transactions must accept the Commonwealth Procurement Card (MasterCard) for payment of services

KENTUCKY SALES AND USE TAXES

Sales of tangible personal property or services to the State of Kentucky and its agencies are not subject to state sales or use taxes. The agency shall furnish the tax exemption number for applicable tax-exempt purchases.

GOVERNMENTAL MANDATES (WORKMAN’S COMPENSATION, UNEMPLOYMENT INSURANCE,

ETC)

The Vendor/Contractor/Proprietor is responsible for compliance with all applicable mandates concerning this agreement. For the purposes of this contract the Vendor/Contractor/Proprietor is deemed to be an independent agent and is not considered to be an employee of the Commonwealth.

COMPLIANCE WITH STATE LAWS

Contracts and orders shall be governed by the laws of the Commonwealth of Kentucky. The rights and obligations of the parties thereto shall be determined in accordance with these laws.

CONTRACT MODIFICATIONS

No modification to this contract shall be permitted unless the contractor receives written approval from the Commonwealth of Kentucky.

If the contractor believes modifications are necessary, he/she may request approval of the Commonwealth of Kentucky. All contract modifications shall be subject to the provisions of 200 KAR 5:311.

The agency reserves the right to modify this agreement for the addition or deletion of requirements deemed necessary by the agency with the mutual agreement of both parties; however, modifications will not result in the expenditures against this contract exceeding $20,000 per fiscal year.

TERMINATION OF CONTRACT

Either party may terminate this agreement at any time for just cause, or either party may cancel this agreement with thirty (30) days written notice.

METHOD OF AWARD

Award will be made to the lowest evaluated responsive, responsible best value offeror. The agency will issue a notification of award accepting the best value offer. Prompt Payment may be considered in award criteria. The scoring of bids/proposals is subject to Reciprocal preference for Kentucky resident bidders and Preferences for a Qualified Bidder or the Department of Corrections, Division of Prison Industries. See below.

ACCESS TO RECORDS

Document Description Page 10

2300000049 Letcher Co AR8 ProV5 CNC Machine Including http://www.lrc.state.ky.us/kar/200/005/330.htm

The contractor, as defined in KRS 45A.030 (9) agrees that the contracting agency, the Finance and Administration Cabinet, the Auditor of Public Accounts, and the Legislative Research Commission, or their duly authorized representatives, shall have access to any books, documents, papers, records, or other evidence, which are directly pertinent to this contract for the purpose of financial audit or program review.

Records and other prequalification information confidentially disclosed as part of the bid process shall not be deemed as directly pertinent to the contract and shall be exempt from disclosure as provided in KRS 61.878(1)(c). The contractor also recognizes that any books, documents, papers, records, or other evidence, received during a financial audit or program review shall be subject to the Kentucky Open Records Act, KRS 61.870 to 61.884.

VALIDITY OF OFFER

This offer is valid for sixty (60) days.

Method of Award Best Value - Ranking Approach

The Commonwealth intends to award a contract to the vendor, whose offer, conforming to the solicitation, is the most advantageous on the basis of "best value" for all products, services, and requirements contained herein.

An evaluation committee, or a designated individual, will evaluate the information provided by the vendor in response to the established measurable criteria contained in the solicitation.

Measurable Criteria: Delete any criteria that is not applicable Cost 90 Points Delivery 5 Points Warranty 5 Points Total Points 100 Points

Each vendor is responsible for submitting all relevant, factual and correct information with their offer to enable the evaluator(s) to afford each vendor the maximum score based on the available data submitted by the Vendor.

A bidder shall submit one (1) response to a solicitation and shall not propose more than one (1) model/brand for each item listed in the solicitation, except for requested tier pricing. Multiple or alternate bids offering more than one (1) bid price in total or by line item shall be rejected.

Vendors responding with the minimum Best Value requirements in this solicitation shall not be credited with Best Value points. Vendors responding with greater than the minimum requirements shall receive Best Value points. Failure to provide adequate information will impact the evaluated points awarded to the vendor.

COST; maximum 90 points The bidder with the lowest Price receives the maximum score. The bidder with the next lowest Price receives points by dividing the lowest Price by the next lowest price and multiplying that percentage by the available points. For example, if 90 points is allocated to the lowest Price criteria for this procurement, bidder "A" bids $3.00 as the lowest bidder and receives the maximum 90 points ($3.00 / $3.00 = 1.00 x 90 = 90). Assume bidder "B" is the next lowest bidder at $4.00, then "B" receives 67.5 points ($3.00 / $4.00) = .75 x 90 = 67.5).

WARRANTY; maximum 5 points

BIDDERS ARE TO ENTER THEIR WARRNTY PERIOD IN MONTHS IN THE SPACE PROVIDED BELOW.

The bidder shall clearly state the warranty for this procurement. Warranty period must be specific and such phrases as, "as required", "as soon as possible", or "prompt" have no meaning and may result in a non-responsive bid.

Vendor shall enter best materials, workmanship & installation warranty period: __________ MONTHS

For example, if the best warranty offer is 24 months, that bidder receives maximum points. If the next best warranty offer is 18 months, that bidder receives 75 points. (18/24 = .75 X 5 = 3.75 points, etc.)

Document Description Page 11

DELIVERY; maximum 5 points

Prompt delivery is desired. That bidder with the Best Delivery offer will received maximum points. Other offers will be scored by dividing the best offer by the next best offer and multiplying the available points by that resulting percentage.

For example, if the best delivery offer is 20 days, that bidder receives maximum points. If the next best delivery offer is 30 days, that bidder receives 3.3 points. (20/30 = .666666 X 5 = 3.3 points, etc.)

BIDDERS ARE TO ENTER THEIR DELIVERY OFFER IN CALENDAR DAYS IN THE SPACE PROVIDED

BELOW.

The bidder shall clearly state the delivery time for this procurement. Delivery time must be specific and such phrases as, "as required", "as soon as possible", or "prompt" have no meaning and may result in a non-responsive bid.

Vendor should enter best delivery time in working days: __________ DAYS ARO

The vendor agrees that when delivery/service is not made within the contracted due date, one percent (1%) per day will be deducted from the vendor’s invoice for each day the vendor fails to meet the contracted delivery/service date.

The Commonwealth reserves the right to negotiate all aspects of the solicitation with the evaluated best value vendor.

Best Value scoring is subject to Reciprocal preference for Kentucky resident bidders and Preferences for a Qualified Bidder or the Department of Corrections, Division of Prison Industries (KAR 200 5:410).

KRS 45A.490 Definitions for KRS 45A.490 to 45A.494.

As used in KRS 45A.490 to 45A.494:

(1) "Contract" means any agreement of a public agency, including grants and orders, for the purchase or disposal of supplies, services, construction, or any other item; and

(2) "Public agency" has the same meaning as in KRS 61.805.

KRS 45A.492 Legislative declarations.

The General Assembly declares:

(1) A public purpose of the Commonwealth is served by providing preference to Kentucky residents in contracts by public agencies; and

(2) Providing preference to Kentucky residents equalizes the competition with other states that provide preference to their residents.

KRS 45A.494 Reciprocal preference to be given by public agencies to resident bidders -- List of states -- Administrative regulations.

(1) Prior to a contract being awarded to the lowest responsible and responsive bidder on a contract by a public agency, a resident bidder of the Commonwealth shall be given a preference against a nonresident bidder registered in any state that gives or requires a preference to bidders from that state. The preference shall be equal to the preference given or required by the state of the nonresident bidder.

(2) A resident bidder is an individual, partnership, association, corporation, or other business entity that, on the date the contract is first advertised or announced as available for bidding:

(a) Is authorized to transact business in the Commonwealth; and

(b) Has for one (1) year prior to and through the date of the advertisement, filed Kentucky corporate income taxes, made payments to the Kentucky unemployment insurance fund established in KRS 341.490, and maintained a Kentucky workers' compensation policy in effect.

(3) A nonresident bidder is an individual, partnership, association, corporation, or other business entity that does not meet the requirements of subsection (2) of this section.

(4) If a procurement determination results in a tie between a resident bidder and a nonresident bidder, preference shall be given to the resident bidder.

(5) This section shall apply to all contracts funded or controlled in whole or in part by a public agency.

(6) The Finance and Administration Cabinet shall maintain a list of states that give to or require a preference for their own resident bidders, including details of the preference given to such bidders, to be used by public agencies in determining resident bidder preferences. The cabinet shall also promulgate administrative

Document Description Page 12 regulations in accordance with KRS Chapter 13A establishing the procedure by which the preferences required by this section shall be given.

(7) The preference for resident bidders shall not be given if the preference conflicts with federal law.

(8) Any public agency soliciting or advertising for bids for contracts shall make KRS 45A.490 to 45A.494 part of the solicitation or advertisement for bids.

The reciprocal preference as described in KRS 45A.490-494 above shall be applied in accordance with

200 KAR 5:400.

Determining the residency of a bidder for purposes of applying a reciprocal preference Any individual, partnership, association, corporation, or other business entity claiming resident bidder status shall submit along with its response the attached Required Affidavit for Bidders, Offerors, and Contractors Claiming Resident Bidder Status. The BIDDING AGENCY reserves the right to request documentation supporting a bidder's claim of resident bidder status. Failure to provide such documentation upon request shall result in disqualification of the bidder or contract termination.

A nonresident bidder shall submit, along with its response, its certificate of authority to transact business in the Commonwealth as filed with the Commonwealth of Kentucky, Secretary of State. The location of the principal office identified therein shall be deemed the state of residency for that bidder. If the bidder is not required by law to obtain said certificate, the state of residency for that bidder shall be deemed to be that which is identified in its mailing address as provided in its bid.

Preferences for a Qualified Bidder or the Department of Corrections, Division of Prison Industries (KAR 200 5:410).

Pursuant to 200 KAR 5:410, and KRS 45A.470, Kentucky Correctional Industries will receive a preference equal to twenty (20) percent of the maximum points awarded to a bidder in a solicitation. In addition, the following "qualified bidders" will receive a preference equal to fifteen (15) percent of the maximum points awarded to a bidder in a solicitation: Kentucky Industries for the Blind, any nonprofit corporation that furthers the purposes of KRS Chapter 163 and any qualified nonprofit agencies for individuals with severe disabilities as defined in KRS 45A.465(3). Other than Kentucky Industries for the Blind, a bidder claiming "qualified bidder" status shall submit along with its response to the solicitation a notarized affidavit which affirms that it meets the requirements to be considered a qualified bidder- affidavit form included. If requested, failure to provide documentation to a public agency proving qualified bidder status may result in disqualification of the bidder or contract termination.

Past Vendor Performance may be considered in the award of this Contract. Vendors with a record of poor performance in the last 12 months may be found non-responsible and ineligible for award.

Successful bidder shall submit an Annual Affidavit for Bidders, Offerors and Contractors prior to issuing an award.

Document Description Page 13

ANNUAL AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS

REQUIRED

AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS PAGE 1 OF 2 FOR BIDS AND

CONTRACTS IN GENERAL:

I. Each bidder or offeror swears and affirms under penalty of perjury, that to the best of their knowledge:

a. In accordance with KRS 45A.110 and KRS 45A.115, neither the bidder or offeror as defined in KRS45A.070(6), nor the entity which he/she represents, has knowingly violated any provisions of the campaign finance laws of the Commonwealth of Kentucky; and the award of a contract to the bidder or offeror or the entity which he/ she represents will not violate any provisions of the campaign finance laws of the Commonwealth.

b. The bidder or offeror swears and affirms under penalty of perjury that, to the extent required by Kentucky law, the entity bidding, and all subcontractors therein, are aware of the requirements and penalties outlined in KRS 45A.485; have properly disclosed all information required by this statute; and will continue to comply with such requirements for the duration of any contract awarded.

c. The bidder or offeror swears and affirms under penalty of perjury that, to the extent required by Kentucky law, the entity bidding, and its affiliates, are duly registered with the Kentucky Department of Revenue to collect and remit the sales and use tax imposed by KRS Chapter 139, and will remain registered for the duration of any contract awarded.

d. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding is not delinquent on any state taxes or fees owed to the Commonwealth of Kentucky and will remain in good standing for the duration of any contract awarded.

e. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, is not currently engaged in, and will not for the duration of the contract engage in, the boycott of a person or an entity based in or doing business with a jurisdiction with which Kentucky can enjoy open trade, as defined in KRS 45A.607.

f. The bidder or offeror swears and affirms that the entity bidding, and all subcontractors therein, have not violated any of the prohibitions set forth in KRS 11A.236 during the previous ten (10) years, and further pledge to abide by the restrictions set forth in such statute for the duration of the contract awarded.

g. The bidder or offeror swears and affirms that they have not procured an original, subsequent, or similar contract while employing an executive agency lobbyist who was convicted of a crime related to the original, subsequent, or similar contract within five (5) years of the conviction of the lobbyist.

FOR “NON-BID” CONTRACTS (I.E. SOLE-SOURCE; NOT-PRACTICAL OR FEASIBLE TO BID; OR

EMERGENCY CONTRACTS, ETC):

Document Description Page 14

II. Each contractor further swears and affirms under penalty of perjury, that to the best of their knowledge:

a. In accordance with KRS 121.056, and if this is a non-bid contract, neither the contractor, nor any member of his/her immediate family having an interest of 10% or more in any business entity involved in the performance of any contract awarded, have contributed more than the amount specified in KRS 121.150 to the campaign of the gubernatorial slate elected in the election last preceding the date of contract award.

ANNUAL AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS

REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS PAGE 2 OF 2

b. In accordance with KRS 121.330(1) and (2), and if this is a non-bid contract, neither the contractor, nor officers or employees of the contractor or any entity affiliated with the contractor, nor the spouses of officers or employees of the contractor or any entity affiliated with the contractor, have knowingly contributed more than $5,000 in aggregate to the campaign of a candidate elected in the election last preceding the date of contract award that has jurisdiction over this contract award.

c. In accordance with KRS 121.330(3) and (4), and if this is a non-bid contract, to the best of his/her knowledge, neither the contractor, nor any member of his/her immediate family, his/her employer, or his/her employees, or any entity affiliated with any of these entities or individuals, have directly solicited contributions in excess of $30,000 in the aggregate for the campaign of a candidate elected in the election last preceding the date of contract award that has jurisdiction over this contract.

As a duly authorized representative for the bidder, offeror, or contractor, I have fully informed myself regarding the accuracy of all statements made in this affidavit, and acknowledge that the Commonwealth is reasonably relying upon these statements, in making a decision for contract award and any failure to accurately disclose such information may result in contract termination, repayment of funds and other available remedies under law. If the bidder, offeror, or contractor becomes non-compliant with any statements during the affidavit effective period, I will notify the Finance and Administration Cabinet, Office of Procurement Services immediately. I understand that the Commonwealth retains the right to request an updated affidavit at any time.

Signature Printed Name Title Date

Commonwealth of Kentucky Vendor Code (if known)

Subscribed and sworn to before me by (Affiant) (Title) of this day of ,20 .

Document Description Page 15

(Company Name) Notary Public [seal of notary] My commission expires:

Document Description Page 16

REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING QUALIFIED

BIDDER STATUS

FOR BIDS AND CONTRACTS IN GENERAL:

I. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, and all subcontractors therein, meets the requirements to be considered a “qualified bidder” in accordance with 200 KAR 5:410(3); and will continue to comply with such requirements for the duration of any contract awarded. Please identify below the particular “qualified bidder” status claimed by the bidding entity.

________ A nonprofit corporation that furthers the purposes of KRS Chapter 163

_______ Per KRS 45A.465(3), a "Qualified nonprofit agency for individuals with severe disabilities" means an organization that:

(a) Is organized and operated in the interest of individuals with severe disabilities; and

(b) Complies with any applicable occupational health and safety law of the United States and the Commonwealth; and

(c) In the manufacture or provision of products or services listed or purchased under KRS 45A.470, during the fiscal year employs individuals with severe disabilities for not less than seventy-five percent (75%) of the man hours of direct labor required for the manufacture or provision of the products or services; and

(d) Is registered and in good standing as a nonprofit organization with the Secretary of State.

The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of qualified bidder status. Failure to provide such documentation upon request may result in disqualification of the bidder or contract termination.

Signature Printed Name

Title Date Company Name Address

Subscribed and sworn to before me by (Affiant) (Title) of this _____day of ____________,20___.

(Company Name)

Notary Public [seal of notary] My commission expires:

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2300000049 Letcher Co AR8 ProV5 CNC Machine Including http://www.lrc.state.ky.us/kar/200/005/410reg.htm

Document Description Page 18