Attachment C Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- Elmer Knopf Learning Center Furniture RFP
- Solicitation number
- RFP GIS 210000001620 2
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement required by the Genesee Intermediate School District in Flint, Michigan, pursuant to Public Act 232 of 2004. The document mandates that all bidders submit a sworn and notarized statement disclosing any familial or business relationships between the bidder, its employees, and members of the Genesee Intermediate School District Board of Education, the District Superintendent, or other District officials. Bids submitted without this completed and notarized statement will not be accepted.
The form requires bidders to provide their company name, address, and contact information, followed by a detailed statement of any business or familial relationships with District personnel. The authorized representative of the contractor or vendor must sign the document in the presence of a notary public, who then acknowledges the instrument with their signature, seal, expiration date, and the county in which the acknowledgment occurred.
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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 .