FORM 2 RFP - AffidavitforClaimingResidentBidderStatus.xml
XML file 66 KB Posted
- Attached to
- FY19-20 DBHDID WSH Podiatry Services C859
- Solicitation number
- RFP 729 1900000066 4
- Issued by
- Clark County, Kentucky
About this file
This is an affidavit form for the Commonwealth of Kentucky used by bidders and offerors claiming resident bidder status in accordance with Kentucky Revised Statutes (KRS) 45A.494(2). The form requires entities bidding on state and local contracts to swear under penalty of perjury that they meet specific residency requirements. To qualify as a resident bidder, the entity must be authorized to transact business in the Commonwealth and must demonstrate continuous compliance with three requirements for the one-year period prior to and through the contract advertisement date: filing Kentucky corporate income taxes, making payments to the Kentucky unemployment insurance fund established under KRS 341.49, and maintaining an active Kentucky workers' compensation policy.
The bidding agency reserves the right to request documentation supporting any claim of resident bidder status, and failure to provide such documentation upon request will result in bidder disqualification or contract termination. The affidavit must be completed with the bidder's signature, printed name, title, date, and company information, and must be notarized before a notary public who will affix their seal and provide their expiration date. This form serves as a standard boilerplate document for contract oversight purposes in Kentucky's procurement process.
Text of this file
REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS CLAIMING RESIDENT BIDDER STATUS FOR BIDS AND CONTRACTS IN GENERAL: The bidder or offeror hereby swears and affirms under penalty of perjury that, in accordance with KRS 45A.494(2), the entity bidding 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: 1. Is authorized to transact business in the Commonwealth; 2. Has for one year prior to and through the date of advertisement A . Filed Kentucky corporate income taxes; B. Made payments to the Kentucky unemployment insurance fund established in KRS 341.49; and C . Maintained a Kentucky workers’ compensation policy in effect. 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. 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: Boilerplates Contracts RFP Affidavit #2 Contract Oversight 4700.00000000000 Boilerplates Contracts Contract Oversight RFP Affidavit #2 Normal 1 1 192 1099 Microsoft Office Word 0 9 2 false Title 1 FY19 Affidavit for Claiming Resident Bidder Status Commonwealth of Kentucky false 1289 false false 16.0000 FY19 Affidavit for Claiming Resident Bidder Status Commonwealth Office of Technology Petrey, Vanessa L (CHFS OATS DPSGO) 2 2018-10-01T18:15:00Z 2018-10-01T18:15:00Z
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