Attachment C Familial Statement.pdf
PDF 15 KB Posted
- Attached to
- 2026 GISD Surveillance Camera RFP
- Solicitation number
- RFP GIS 260000002359 1
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement form required by the Genesee Intermediate School District (GISD) in Flint, Michigan, pursuant to Public Act 232 of 2004. The form must accompany all bids submitted in response to the 2026 GISD Surveillance Camera RFP. The document establishes mandatory disclosure requirements for bidders to identify any familial or business relationships existing between the bidder, its employees, and members of the GISD Board of Education, the District Superintendent, or other District officials. Bids that do not include a completed, sworn, and notarized statement will not be accepted.
The form requires bidders to provide contractor/vendor information including name, address, and contact number, followed by a detailed statement of any business or familial relationships. The authorized representative of the contractor must sign and date the document, and a notary public must acknowledge the instrument before a notary seal and signature, with notation of the county, date, state, and notary commission expiration. This disclosure mechanism serves as a conflict-of-interest safeguard to ensure procurement integrity and transparency in the bidding process for the District.
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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 .