Attach C Familial Statement_.pdf
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- Attached to
- GCI Field House Technology RFP
- Solicitation number
- RFP GIS 210000001506 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, in compliance with Public Act 232 of 2004. The form must accompany all bids submitted to the District and serves to ensure transparency regarding any familial or business relationships between bidders, their employees, and members of the District's Board of Education, Superintendent, or other District officials. Bidders are required to provide their organization name, address, and contact information, along with a detailed disclosure of any such relationships. The statement must be sworn and notarized before a notary public, with the authorized representative of the contractor or vendor signing and dating the document before the notary seal is applied. Any bid submitted without this completed and notarized statement will be rejected and deemed non-responsive.
This disclosure requirement applies uniformly to all bidders and respondents and is a mandatory compliance document rather than a pricing or service-specific document. The form does not address contract pricing, set-asides, funding sources, or project-specific terms, as its sole purpose is to establish a mechanism for disclosing potential conflicts of interest and ensuring the integrity of 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
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