GenNET Telephone Services RFP 2019 - 04 - Attachment C - Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- GenNET Telephone Service
- Solicitation number
- RFP GIS 200000000373 2
- Issued by
- Genesee County, Michigan
About this file
This is a Familial Relationship Disclosure Statement required by Public Act 232 of 2004 for the GenNET Telephone Services RFP 2019-04 issued by the Genesee Intermediate School District, located in Flint, Michigan. All bids submitted in response to this solicitation must be accompanied by a sworn and notarized statement disclosing any familial or other business relationships existing between the bidder, all employees of the bidder, and any member of the Genesee Intermediate School District Board of Education, the Superintendent, or any other official of the District. Bids that do not include this required disclosure statement will not be accepted.
The statement requires the contractor or vendor respondent to provide their name, address, and contact number, followed by a detailed description of any business or familial relationships. The authorized representative of the contractor or vendor must sign and date the statement, and it must be notarized by a Notary Public who attests to the acknowledgment of the instrument, including the county, state, date, and expiration of the notary commission.
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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 .