APPENDIX D Familial Disclosure Form (ONLY REQUIRED FOR CONSTRUCTION).docx
DOCX document 22 KB Posted
- Attached to
- IFB 26. 0001 Allen Elementary Boiler Replacement
- Solicitation number
- IFB 26.0001 Allen Elementary Boiler Replacement
- Issued by
- Washtenaw County, Michigan
About this file
This document is a Familial Disclosure Form for Invitation for Bid (IFB) 26.0001 for Allen Elementary Boiler Replacement, issued by Ann Arbor Public Schools in Michigan. The form is specifically required for construction contractors bidding on a project involving the replacement of three boilers at Allen Elementary School. Pursuant to Michigan law (MCL 380.1267), contractors must disclose any familial relationships between their ownership/employees and members of the Ann Arbor Public Schools Board of Education or the Superintendent.
The disclosure form requires contractors to provide a sworn and notarized statement detailing any familial relationships, with the completed form to be submitted alongside the bid. The document includes spaces for the contractor's representative to print their name, provide a signature, list their title, and have the statement notarized. Additional details about Board of Education members can be found on the district's website (www.a2schools.org). The form is a mandatory component of the bidding process, ensuring transparency and potential conflict of interest disclosure for this public school infrastructure project.
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Other files
| File | Type | Posted |
|---|---|---|
| APPENDIX E Ichat packet 5-2021.pdf | ||
| APPENDIX B Certification Form.docx | DOCX document | |
| APPENDIX H BID PRICING FORM.docx | DOCX document | |
| APPENDIX I Prevaliling Wage.pdf | ||
| APPENDIX G MECHANICAL PLANS MODIFIED.pdf | ||
| APPENDIX F SPECIFICATIONS.docx | DOCX document | |
| APPENDIX C Iran Economic Sanctions Form.docx | DOCX document | |
| IFB 26.0001 ALLEN ELEMENTARY BOILER REPLACEMENT.docx | DOCX document | |
| APPENDIX A Contractor Information.docx | DOCX document |
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Text version
IFB 26.0001 ALLEN ELEMENTARY BOILER REPLACEMENT
APPENDIX D - NOTARIZED FAMILIAL DISCLOSURE STATEMENT
(Return completed and notarized form with bid)
Pursuant to MCL 380.1267, a sworn and notarized statement disclosing any familial relationships that exists between the owner or any employee of the contractor, and any member of the Board of Education of Ann Arbor Public Schools or the Superintendent of Ann Arbor Public Schools shall be accompanied with the bid. A list of the Board of Education members and its Superintendent may be found at www.a2schools.org.
List any familial relationships:
Contractor:
The undersigned, the owner or authorized representative of the contractor does hereby represent and warrant that the disclosure statement herein is true to the best of my knowledge.
Print Name Signature of Contractor representative
Title
STATE OF MICHIGAN __________________________)
) SS.
COUNTY OF __________________________)
This document was acknowledged before me on the ____ day of _______________, 20___, by
(Signature of Notary)
_________________________________Notary Public
_________________________County, _________________
My commission expires: ___________________
Acting in the County of: ___________________
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