26-0069 Attachment G- Familial Disclosure (1).PDF
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- Solicitation number
- RFP-DET-250000002601-3
- Issued by
- Wayne County, Detroit City, Michigan
About this file
This document is a Familial Relationship Disclosure form for the Detroit Public Schools Community District (DPSCD), specifically related to facilities-related services, construction, additions, and renovations. The form is mandatory for bidders and must be completed, notarized, and submitted with the bid proposal, with failure to do so resulting in automatic bid disqualification.
The disclosure form requires bidders to transparently report any familial relationships between the bidder's owners or employees and members of the DPSCD Board or its Superintendent, as mandated by Michigan law (MCL 380.1267). The form provides space for listing multiple familial relationships and includes an option to affirm that no such relationships exist. Bidders must sign, print their name, provide their title, and have the document notarized, with the notary public completing the requisite certification section to validate the disclosure statement.
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Appendix D – Familial Relationship Disclosure
FAMILIAL RELATIONSHIP DISCLOSURE
(Facilities Related Services, Construction, Additions and Renovations)
(MUST return completed and notarized with bid)
Pursuant to MCL 380.1267, a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the Board of Detroit Public Schools Community District or its Superintendent must be accompanied with the bid. Failure to return this notarized statement/signature with the bid will result in bid disqualification.
The following are the familial relationship(s):
Owner/Employee Name Related to: Relationship
1.
2.
3.
4.
5.
Attach additional pages if necessary to disclose all familial relationships.
There is no familial relationship that exists between the owner or any employee of the bidder and any member of the Board of Detroit Public Schools Community District or its Superintendent.
The undersigned, the owner or authorized representative of bidder (insert name) does hereby Represent and warrant that the disclosure statements herein contained are true.
Print Name Signature of Bidder Representative
Title
STATE OF MICHIGAN )
) ss
COUNTY OF )
This instrument was acknowledged before me on the day of , , By .
Notary Public
My commission expires: / / Acting in the County of:
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