Attachment C Familial Statement.pdf
PDF 15 KB Posted
- Attached to
- 2025 GISD Surveillance Camera RFP
- Solicitation number
- RFP-GIS-250000002674-2
- Issued by
- Genesee County, Michigan
About this file
This document is a Familial Relationship Disclosure Statement from the Genesee Intermediate School District (GISD) located in Flint, Michigan, required under Public Act 232 of 2004. The form mandates that all bidders must submit a sworn and notarized statement disclosing any familial or business relationships between the bidder, the bidder's employees, and GISD Board of Education members, the Superintendent, or other district officials. Bids submitted without this completed disclosure statement will not be accepted.
The document is a standard form template designed to ensure transparency and prevent potential conflicts of interest in the bidding process. It provides space for the contractor/vendor/respondent to provide their name, address, contact information, and details about any existing relationships with district personnel. The form requires a signature from the person authorized to bind the respondent and must be notarized, with space for the notary public to complete their official certification.
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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 .