Attachment C Familial Statement.pdf

PDF 15 KB Posted

Attached to
Early Head Start Furniture
Solicitation number
RFP GIS 190000002221 1
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, in compliance with Public Act 232 of 2004. All bidders responding to District solicitations must submit a sworn and notarized statement disclosing any familial or business relationships existing between the bidder's employees and members of the Genesee Intermediate School District Board of Education, the District Superintendent, or any other District official. Bids that do not include this completed and notarized statement will not be accepted.

The form requires the contractor, vendor, or respondent to provide their name, address, and contact number, detail any business or familial relationships in a statement section, and include signatures from a person authorized to bind the contractor as well as a notary public. The notary must acknowledge the statement before a notary public and include the notary's signature, date, commission expiration, and county of service. This disclosure requirement is mandatory for bid submission and serves to ensure transparency and prevent conflicts of interest in the District's procurement process.

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Other files

File Type Posted
Attachment D Vendor Certification.pdf PDF
Attachment B Bid Form.pdf PDF
Attachment A Project Description.pdf PDF
Instructions to Bidders.pdf PDF

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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 .