Attachment C Familial Statement.pdf
PDF 15 KB Posted
- Attached to
- 2026 GISD Surveillance Camera RFP
- Solicitation number
- RFP GIS 260000002359 2
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement required by the Genesee Intermediate School District (GISD) located in Flint, Michigan, for the 2026 Surveillance Camera RFP. The document is mandated under Public Act 232 of 2004 and must accompany all bids submitted in response to this solicitation. Bidders are required to disclose any familial or business relationships existing between the bidder's employees and members of the GISD Board of Education, the District Superintendent, or any other District official. The statement must be completed with the contractor or vendor's name, address, and contact information, along with a detailed description of any business or familial relationships.
The disclosure statement must be sworn and notarized before submission, with signatures and seals from both an authorized representative of the contractor or vendor and a notary public. Any bids submitted without this completed and notarized statement shall be rejected and will not be accepted. The notarization must include the notary public's signature, the date of acknowledgment, the county and state where the acknowledgment took place, and the expiration date of the notary's commission.
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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 .