Attachment C Familial Statement.pdf

20 KB Posted

Attached to
GCI Phase II Furniture Bid
Solicitation number
RFP GIS 180000003226 1
Issued by
Genesee County, Michigan

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This is a Familial Relationship Disclosure Statement form required by the Genesee Intermediate School District located in Flint, Michigan, pursuant to Public Act 232 of 2004. The document serves as a mandatory disclosure requirement for all bidders and vendors responding to solicitations from the District, establishing that bidders must certify any familial or business relationships existing between the bidder's employees and members of the Genesee Intermediate School District Board of Education, the Superintendent, or other District officials.

All bids submitted to the Genesee Intermediate School District must include a completed, sworn, and notarized version of this disclosure statement. Failure to provide the executed statement will result in bid rejection. The form requires the contractor or vendor to provide company name and address, contact information, and a detailed statement of any business or familial relationships with District personnel. The document must be signed by an authorized representative of the bidding entity and acknowledged before a Notary Public, with the notarization indicating the county, date, and expiration of the notary's commission.

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Other files

File Type Posted
Attachment D Vendor Certification.pdf PDF
Attachment A Project Description.pdf PDF
GCI Phase II - Attachment B.xlsx XLSX spreadsheet
Instruction to Bidders.pdf PDF

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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

Name:
Address:
undefined:
fill_20:
Statement of Business or Familial Relationship 1:
Statement of Business or Familial Relationship 2:
Statement of Business or Familial Relationship 3:
Print Name:
Title:
Date:
This instrument was acknowledged before me a Notary Public in and for 1:
This instrument was acknowledged before me a Notary Public in and for 2:
on this:
20:
undefined_2:
Date_2:
My Commission Expires:
Acting in the County of:

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