GenNET Backup Equipment RFP 2019 - 04 - Attachment C - Familial Statemen....pdf
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- Attached to
- GenNET Backup Equipment
- Solicitation number
- RFP GIS 190000002755 1
- Issued by
- Genesee County, Fife Lake Village, Michigan
About this file
This is a Familial Relationship Disclosure Statement form required by the Genesee Intermediate School District in Flint, Michigan, in accordance with Public Act 232 of 2004. The document serves as a mandatory attachment (Attachment C) to the GenNET Backup Equipment RFP 2019-04 and must accompany all bids submitted in response to this procurement opportunity. The form requires bidders to disclose any familial or business relationships existing between the bidder, its employees, and members of the Genesee Intermediate School District Board of Education, the District Superintendent, or other District officials. Bids submitted without a completed, sworn, and notarized disclosure statement will not be accepted.
The statement must be executed by a person authorized to bind the contractor or vendor and notarized in the county where the acknowledgment occurs. The form provides space for the contractor or vendor to enter their name, address, and contact information, along with detailed disclosure of any business or familial relationships. The notary public must certify the acknowledgment with their signature, date, and commission expiration information, along with the county in which they are acting.
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Text version
GENESEE INTERMEDIATE SCHOOL DISTRICT
ERWIN L. DAVIS EDUCATION CENTER
2413 WEST MAPLE AVENUE
FLINT, MI 48507-3493
PUBLIC ACT 232 OF 2004
FAMILIAL RELATIONSHIP DISCLOSURE STATEMENT
All bids must be accompanied by a sworn and notarized statement disclosing any familial, or other business relationship existing between the bidder (respondent to this Bid) and all employees of the bidder and any member of the Genesee Intermediate School District Board of Education, the Superintendent of the District and/or any other official of the District. Any bids that do not include this sworn and notarized statement shall not be accepted.
Owner Name & Address:
Genesee Intermediate School District 2413 West Maple Avenue
Flint, MI 48507-3493
Contractor/Vendor/Respondent Information:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
Contact Number: ______________________________________________________________
Statement of Business or Familial Relationship:
Person Authorized to Bind the Contractor/Vendor/Respondent:
Print Name Title
Signature Date
Seal:
This instrument was acknowledged before me, a Notary Public, in and for ___________________________ County, _____________________ on this _________ day of ________________________, 20_________.
State
Notary Public Signature Date
My Commission Expires: _______________________
Acting in the County of: ________________________
Attachment C
File details come from the government source that posted it. Updated .