amount specified in KRS 121.150 to the campaign of the gubernatorial slate elected in the election last preceding the date of contract award.
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 Kentucky State University 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 Kentucky State University Purchasing Department immediately. I understand that Kentucky State University retains the right to request an updated affidavit at any time.
SIGNATURE REQUIRED: This proposal cannot be considered valid unless signed and dated by an authorized agent of the Firm. Type or print the signatory's name, title, address, phone number and fax number in the spaces provided.
Company Name Authorized Signature Date
Address Typed or Printed Name
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Phone Number Federal Identification Number