Attach C Familial Statement_.pdf
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- Attached to
- 4-Post Alignment RFP
- Solicitation number
- RFP GIS 200000000070 3
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement form required by the Genesee Intermediate School District in Flint, Michigan, pursuant to Public Act 232 of 2004. The form must accompany all bids submitted to the district and serves as a sworn and notarized declaration of any familial or business relationships existing between the bidder, the bidder's employees, and members of the Genesee Intermediate School District Board of Education, the Superintendent, or other district officials. Bids submitted without this completed and notarized statement will not be accepted by the district.
The form requires the contractor, vendor, or respondent to provide their name, address, and contact information, followed by a detailed statement of any business or familial relationships with district personnel. The authorized representative of the bidding entity must sign and date the form, and the signature must be notarized by a Notary Public in the county where the acknowledgment occurs. The notary must provide their signature, date, commission expiration date, and the county in which they are acting.
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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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