Resident_&_Non_Resident_Status_Forms.pdf

KENTON COUNTY AIRPORT BOARD

CERTIFICATION AS TO KENTUCKY RESIDENT STATUS

1. Kentucky law provides that a Kentucky resident Bidder shall be given a preference against a nonresident Bidder equal to the preference given or required by the state of the nonresident Bidder, unless such preference conflicts with federal law. In addition, if a procurement determination results in a tie between a Kentucky resident Bidder and a non-resident Bidder, preference shall be given to the Kentucky resident Bidder.

2. To be eligible to be considered as a Kentucky resident Bidder, a Bidder must: (i) satisfy the requirements set forth under Sections 3(a) and (b) below; and (ii) properly complete this certification and submit it with the Bid. Do not sign and submit this certification unless you meet each of the requirements set forth below under Sections 3(a) and (b) below. If a Bidder does not meet the requirements set forth below under Sections 3(a) and (b) the Bidder must furnish a Certification as to Non-Resident Status contained within this solicitation.

3. The undersigned, by subscribing to this certification, certifies under oath and upon penalties of perjury, that each of the following is true and correct and that the Bidder can furnish proof upon request by KCAB that each of the following is true and correct:

That on the date this Invitation to Bid was first advertised or announced as available for bidding:

(a) The Bidder was authorized to transact business in the Commonwealth; and

(b) That the Bidder has during the one (1) year period prior to and through the date of the advertisement for this Invitation to Bid: (i) filed Kentucky Corporate Income Taxes; (ii) made payments to the Kentucky Unemployment Insurance Fund; and (iii) maintained a Kentucky Workers Compensation Policy in effect.

Prior to an award to a Kentucky resident Bidder, KCAB may require the Bidder to furnish proof satisfactory to KCAB that the Bidder meets each of the requirements set forth in (a) and (b) above.

Failure to timely submit such proof upon KCAB’s request may result in the lack of a preference being applied.

By certifying and signing below, I certify that each of the foregoing is true and correct for the Bidder submitting this Bid.

BIDDER:

By: ____________________________ Signature of authorized officer/agent

Its: _____________________________ Title of authorized officer/agent

STATE OF ______________________

COUNTY OF ____________________

The foregoing certification was sworn to and acknowledged before me this ______ day of ______, 20___ by ___________________________ (name), the __________________ (title), for and on behalf of the bidder.

Notary Public My Commission Expires: _________________ My Jurisdiction Is: ______________________

KENTON COUNTY AIRPORT BOARD

CERTIFICATION AS TO NON-RESIDENT STATUS

1. If a Bidder is ineligible to submit a Certification as to Kentucky Resident Status, the Bidder must complete this Certification as to Non-Resident Status.

2. Identify below each state in which the Bidder qualifies as a resident for purposes of receiving a preference in that state:

a. __________________________________

b. __________________________________

c. __________________________________

3. For each state in which the Bidder qualifies as a resident for purposes of receiving a preference under Section 2, above, for each such state list below the preference given or required by that state.

a. __________________________________

b. __________________________________

c. __________________________________

By certifying and signing below, I certify that each of the foregoing is true and correct for the Bidder submitting this Bid.

BIDDER:

By: _____________________________ Signature of authorized officer/agent

Its: _____________________________ Title of authorized officer/agent