Attachment C Familial Statement.pdf

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Attached to
GEC Furniture RFP
Solicitation number
RFP - GIS - 240000000852
Issued by
Genesee County, Flint City, Michigan

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This document is a Familial Relationship Disclosure Statement required for a bid submission to the Genesee Intermediate School District (the District) located in Flint, Michigan. The statement discloses any familial or business relationships between the bidder and the District's employees, superintendent, or board of education members. All bids submitted to the District must include this sworn and notarized statement, or they will not be accepted.

The related state and local contract opportunity is for the GEC Furniture RFP, which is being issued by the District and the City of Flint. The contract is for the provision of furniture to these jurisdictions located in Genesee County, Michigan. No other details about the project scope, quantities, timeline, or award process are provided in this disclosure statement.

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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

File details come from the government source that posted it. Updated .