Fillable - 3306-F-1 Familial Disclosure Affidavit.docx
DOCX document 48 KB Posted
- Attached to
- District Wide S2 Access Control Expansion
- Solicitation number
- RFP - ALMA - 240000001858
- Issued by
- Gratiot County, Michigan
About this file
The document is a Familial Disclosure Affidavit to accompany construction bids, required by the District in the state of Michigan. The affidavit requires the contractor to disclose any familial relationships between the contractor's owner(s) and employee(s) and the District's Superintendent and/or Board members. The contractor must have the authority to bind the company to the representations made in the affidavit, which the District will rely on in evaluating bids. The related state and local contract opportunity is for a District Wide S2 Access Control Expansion project in Gratiot County, Michigan.
The affidavit does not provide any additional details about the contract opportunity, such as product or service requirements, quantities, response dates, award information, or contract term. The document is focused solely on the familial disclosure requirements for contractors bidding on the project.
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Text version
3306-F-1 Familial Disclosure Affidavit to Accompany Construction Bids Series 3000: Operations, Finance, and Property
| 3300 | Facilities, Real, and Personal Property |
| 3306-F-1 | Familial Disclosure Affidavit to Accompany Construction Bids |
Affidavit of (Name)_________________________________
| State of Michigan | ) |
| )ss | |
| County of | ) |
(Name)___________________________ makes this Affidavit under oath and states as follows:
I am a/the:
| ☐ | President |
| ☐ | Vice President |
| ☐ | Chief Executive Officer |
| ☐ | Member |
| ☐ | Partner |
| ☐ | Owner |
| ☐ | Other (please specify) _________________________ |
of ______________________________________ (the “Contractor”).
I have personal knowledge and/or I have personally verified that the following are all of the familial relationships existing between the owner(s) and the employee(s) of the Contractor and the District’s Superintendent and/or Board members:
I have authority to bind the Contractor with the representations contained herein, and I am fully aware that the District will rely on my representations in evaluating bids.
I declare the above information to be true to the best of my knowledge, information, and belief. I could completely and accurately testify regarding the information contained in this Affidavit if requested to do so.
Signature of Affiant
Date
Subscribed and sworn before me in _________________ County, Michigan, on the _____ day of ____________________, 20____ ____________________________________________ (signature) ____________________________________________ (printed) Notary public, State of Michigan, County of _________________ My Commission expires on ______________________________ Acting in the County of _________________________________
| © 2021 | Page 1 of 2 |
| © 2021 | Page 2 of 2 |
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