GenNET Fiber Maintenance RFP 2018 - 04 - Attachment C - Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- Fiber Maintenance
- Solicitation number
- RFP-GIS-190000000453-2
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement form required by Public Act 232 of 2004 for the Genesee Intermediate School District's Erwin L. Davis Education Center in Flint, Michigan. The form must accompany all bids submitted to the district and requires bidders to disclose any familial or business relationships between the bidder's employees and members of the Genesee Intermediate School District Board of Education, District Superintendent, or other district officials. Bids submitted without this sworn and notarized statement will not be accepted.
The form requires contractors/vendors to provide their business contact information and explicitly state any business or familial relationships that exist. It must be signed by a person authorized to bind the contractor, witnessed by a notary public, and include the notary's commission expiration date and county of operation. This document appears to be Attachment C of a larger bid package.
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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 .