Attach C Familial Statement_.pdf
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- Solicitation number
- RFP GIS 210000001110 1
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement required by the Genesee Intermediate School District in Flint, Michigan, pursuant to Public Act 232 of 2004. The document serves as a mandatory attachment to all bids submitted to the District and must be completed, sworn, and notarized by the bidder or contractor. The statement requires disclosure of any familial or other business relationships existing between the bidder, all employees of the bidder, and any member of the Genesee Intermediate School District Board of Education, the Superintendent, or any other District official. Bids that do not include a completed and properly executed familial relationship disclosure statement will not be accepted.
The form includes fields for the contractor or vendor to provide their name, address, and contact number, followed by a section for the statement of business or familial relationship. The document must be signed by a person authorized to bind the contractor or vendor and requires notarization before a Notary Public, who must complete the acknowledgment section with their signature, date, commission expiration, and the county in which the acknowledgment was made. This disclosure requirement is a compliance mechanism designed to ensure transparency and prevent conflicts of interest in the District's procurement process.
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Text version
GENESEE INTERMEDIATE SCHOOL DISTRICT
ERWIN L. DAVIS EDUCATION CENTER
2413 WEST MAPLE AVENUE
FLINT, MI 48507-3493
PUBLIC ACT 232 OF 2004
FAMILIAL RELATIONSHIP DISCLOSURE STATEMENT
All bids must be accompanied by a sworn and notarized statement disclosing any familial, or other business relationship existing between the bidder (respondent to this Bid) and all employees of the bidder and any member of the Genesee Intermediate School District Board of Education, the Superintendent of the District and/or any other official of the District. Any bids that do not include this sworn and notarized statement shall not be accepted.
Owner Name & Address:
Genesee Intermediate School District 2413 West Maple Avenue
Flint, MI 48507-3493
Contractor/Vendor/Respondent Information:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
Contact Number: ______________________________________________________________
Statement of Business or Familial Relationship:
Person Authorized to Bind the Contractor/Vendor/Respondent:
Print Name Title
Signature Date
Seal:
This instrument was acknowledged before me, a Notary Public, in and for ___________________________ County, _____________________ on this _________ day of ________________________, 20_________.
State
Notary Public Signature Date
My Commission Expires: _______________________
Acting in the County of: ________________________
Attachment C
File details come from the government source that posted it. Updated .