Attachment D - Appendix D - Familial Disclosure.pdf
PDF 448 KB Posted
- Solicitation number
- RFP DET 270000000026 2
- Issued by
- Wayne County, Detroit City, 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 bidders disclose any familial relationships between the owner or employees of the bidding company and members of the Detroit Public Schools Board or its Superintendent. Bidders must complete the disclosure statement, listing any related individuals and their relationships, and submit the notarized form with their bid. Failure to provide the completed and notarized disclosure statement will result in automatic bid disqualification.
The form requires the bidder's owner or authorized representative to sign and represent that all disclosed information is true and accurate. The document must be acknowledged before a notary public, who will certify the signature and provide their commission expiration date and county of service. This disclosure requirement is mandated under Michigan statute MCL 380.1267 and serves as a compliance mechanism to ensure transparency and prevent conflicts of interest in the procurement process.
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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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