Attachment C Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- GenNET Firewall Maintenance RFP
- Solicitation number
- RFP-GIS-250000002479-1
- Issued by
- Genesee County, Flint City, Michigan
About this file
This document is a Public Act 232 of 2004 Familial Relationship Disclosure Statement for the Genesee Intermediate School District (GISD) located in Flint, Michigan. The form requires potential bidders, contractors, or vendors to disclose any familial or business relationships between their organization and GISD employees, board members, the superintendent, or other district officials. Any bid submitted without this sworn and notarized statement will be automatically rejected.
The disclosure statement is a mandatory attachment for bid submissions, designed to ensure transparency and prevent potential conflicts of interest. The form provides space for the contractor/vendor to provide their name, address, contact information, and a detailed statement of any existing business or familial relationships. The document must be signed by an authorized representative and notarized, with specific fields for the notary public to complete, including county, state, date, and commission expiration.
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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 .