Attachment D - Appendix D - Familial Disclosure.pdf
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- Solicitation number
- RFP DET 270000000026 1
- Issued by
- Wayne County, Michigan
About this file
This is a Familial Relationship Disclosure form required by the Detroit Public Schools Community District for bidders on facilities-related services, construction, additions, and renovations projects, including the Pershing High School Bid Pack 2C for Signage and Final Cleaning in Michigan. The form mandates that all bidders submit a sworn and notarized statement disclosing any familial relationships between the bidder's owner or employees and members of the Detroit Public Schools Board or its Superintendent. Bidders must complete the disclosure by identifying specific individuals and their relationships, or affirm that no such familial relationships exist. Failure to return the completed and notarized statement with the bid will result in automatic bid disqualification.
The disclosure form requires the signature and notarization of the bidder's owner or authorized representative, along with their printed name and title. The notary public must acknowledge the instrument and provide their commission expiration date and acting county. This requirement is established under Michigan Compiled Law Section 380.1267 and serves as a conflict-of-interest safeguard for the procurement process. Bidders must attach additional pages if necessary to fully disclose all familial relationships.
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Appendix D – Familial Relationship Disclosure
FAMILIAL RELATIONSHIP DISCLOSURE
(Facilities Related Services, Construction, Additions and Renovations)
(MUST return completed and notarized with bid)
Pursuant to MCL 380.1267, a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the Board of Detroit Public Schools Community District or its Superintendent must be accompanied with the bid. Failure to return this notarized statement/signature with the bid will result in bid disqualification.
The following are the familial relationship(s):
Owner/Employee Name Related to: Relationship
1.
2.
3.
4.
5.
Attach additional pages if necessary to disclose all familial relationships.
There is no familial relationship that exists between the owner or any employee of the bidder and any member of the Board of Detroit Public Schools Community District or its Superintendent.
The undersigned, the owner or authorized representative of bidder (insert name) does hereby Represent and warrant that the disclosure statements herein contained are true.
Print Name Signature of Bidder Representative
Title
STATE OF MICHIGAN )
) ss
COUNTY OF )
This instrument was acknowledged before me on the day of , , By .
Notary Public
My commission expires: / / Acting in the County of:
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