Familial Disclosure Statement.pdf
PDF 88 KB Posted
- Attached to
- LIGHTING INSTALLATION
- Solicitation number
- RFP SPSD 260000001328 1
- Issued by
- Saginaw County, Michigan
About this file
This is a Familial Disclosure Statement required by the School District of the City of Saginaw, Michigan. The document serves as a sworn and notarized certification in which bidders must disclose any familial relationships that exist between the bidder's owner or employees and members of the Board of Education or the Superintendent. The statement requires bidders to list the names of owners or employees, the related board members or superintendent, and the specific nature of the familial relationship. If no familial relationships exist, bidders must certify that fact on the form.
The document must be completed, signed by an authorized bidder representative with printed name and title, and notarized before a Michigan notary public. The notary must complete the jurat section indicating the date of notarization, the county where it was executed, the signatory's signature, and the notary's commission expiration date. This disclosure requirement ensures transparency and helps the school district identify potential conflicts of interest in the bidding process.
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Text version
Sworn and Notarized Familial Disclosure Statement
The undersigned, the owner or authorized officer of __________________________________ (the
“Bidder”), hereby represents and warrants except as provided below, that no familial relationships exist between the owner or any employee of the bidder and any member of the Board of Education or the
Superintendent of the School District of the City of Saginaw.
The following are the familial relationship(s)
Owner/Employee Name: Related To: Relationship:
There are no familial relationships that exist between the owner or employee(s) of the Bidder.
BIDDER:
By: __________________________________
Printed Name & Title:
STATE OF MICHIGAN )
)ss.
COUNTY OF _______________)
Subscribed and sworn before me, this _________ day of __________________, 20____, in and for
________________________ County, Michigan by ____________________________________________________
(Signature) NOTARY PUBLIC
My Commission Expires _________________________________
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