Familial Disclosure Statement.pdf
PDF 82 KB Posted
- Attached to
- Window Replacement at Vassar Junior/High School
- Solicitation number
- RFP VPS 200000000525 2
- Issued by
- Van Buren County, Michigan
About this file
This is a Familial Relationship Disclosure Statement required by Vassar Public Schools in Michigan pursuant to MCL 380.1267. The document mandates that bidders submit a sworn and notarized statement disclosing any familial relationships between the bidder's owner or employees and members of Vassar Public Schools' Board of Education or the Superintendent. The Board members identified are Rob Atwood, Jon Genow, Russell Hubbard, Matt Koch, Jeremy LaPratt, Randal Middlin, and Jon Ward, with Dorothy Blackwell serving as Superintendent. Bidders must complete the disclosure form by listing the owner or employee name, the related Board member or Superintendent, and the nature of the relationship. Failure to return the completed, notarized statement with the bid will result in automatic bid disqualification.
The document requires that the bidder's owner or authorized representative sign and print their name on the disclosure form and have it notarized before a notary public. The notary must acknowledge the instrument, document the date of acknowledgment, identify the county in which the notarization occurred, and provide their commission expiration date. Bidders may also indicate that no familial relationships exist by checking the appropriate box. This disclosure requirement serves as a conflict-of-interest safeguard to ensure the integrity of the procurement process and must be completed regardless of whether relationships exist.
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Other files
| File | Type | Posted |
|---|---|---|
| Bid Advertisement.pdf |
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Text version
FAMILIAL RELATIONSHIP DISCLOSURE
(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 Vassar Public Schools’ Board or Vassar Public Schools’ Superintendent must be accompanied with the bid. Failure to return this notarized statement/signature with the bid will result in bid disqualification. The members of Vassar Public Schools’ Board are: Rob Atwood, Jon Genow, Russell Hubbard, Matt Koch, Jeremy LaPratt, Randal Middlin, Jon Ward, and Vassar Public Schools’ Superintendent is Dorothy Blackwell.
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 Vassar Public Schools’ Board, or Vassar Public Schools’ 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
_________________County, Michigan My commission expires: ____/____/____ Acting in the County of: _____________
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