Attachment C Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- Mechatronics Equipment RFP
- Solicitation number
- RFP GIS 210000002623 1
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement form issued by the Genesee Intermediate School District in Flint, Michigan, as required under Public Act 232 of 2004. The form mandates that all bidders and respondents submit a sworn and notarized statement disclosing any familial or other business relationships existing between the bidder, its employees, and members of the Genesee Intermediate School District Board of Education, the District Superintendent, or any other District official. Bids submitted without this completed and notarized disclosure statement will not be accepted.
The form requires contractors, vendors, or respondents to provide their name and address, contact information, and a detailed statement of any business or familial relationships with District personnel. A person authorized to bind the contractor must sign and date the statement, and the document must be notarized before a Notary Public in the appropriate county. The notary must acknowledge the instrument, provide their signature, date, and commission expiration information, and identify the county in which they are acting.
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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 .