Attachment A - Familial Disclosure Form ERate.pdf
PDF 136 KB Posted
- Solicitation number
- RFP EUP 260000000905 7
- Issued by
- Chippewa County, Michigan
About this file
This is a Familial Disclosure Form affidavit for the Eastern Upper Peninsula Intermediate School District related to an E-Rate CAT 2 bid solicitation. The form requires an authorized representative of the bidding contractor to declare under oath all familial relationships existing between the contractor's owners and employees and the school district's superintendent and board members. The affiant must confirm personal knowledge or verification of such relationships and affirm authority to bind the contractor with the representations made in the disclosure.
The document serves as a conflict-of-interest disclosure mechanism requiring notarization before a Michigan notary public. Completion of this affidavit is mandatory as part of the bid submission process, as the school district relies on accurate familial relationship disclosures when evaluating bids. The form does not specify pricing, contract term, or service details but functions as a prerequisite compliance document for bid consideration.
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Text version
Attachment A – Familial Disclosure Form
AFFIDAVIT OF (insert name of affiant)
STATE OF MICHIGAN )
) SS
COUNTY OF __________________________)
____________________________________________ makes this Affidavit under oath and states as follows: (Insert name of affiant)
1. I am a/the:
❏ President ❑ Vice-President
❏ Chief Executive Officer ❑ Member
❏ Partner ❑ Owner
❏ Other (please specify)__________________________________________________ of______________________________________________________, a bidder for Erate CAT 2 for Eastern Upper Peninsula Intermediate School District.
2. I have personal knowledge and/or I have personally verified that the following are all of the familial relationships existing between the owner(s) and the employee(s) of the aforementioned contractor and the school district’s superintendent and/or board members.
3. I have the authority to bind the aforementioned contractor with the representations contained herein, and I am fully aware that the school district will rely on my representations in evaluating bids for the transportation services.
4. I declare the above information to be true to the best of my knowledge, information and belief. I can completely and accurately testify regarding the information contained in this affidavit if requested to do so.
(Signature of affiant) (Date)
Subscribed and sworn before me in ______________________________ County, Michigan on the ____ day of ______________________________, 20____.
Signature: ________________________________________________________ Printed Name: ________________________________________________________ Notary Public, State of Michigan, County of _________________________________.
My Commission expires on _______________________________________________.
Acting in the County of __________________________________________________.
File details come from the government source that posted it. Updated .