GISD - New Building Fiber 2019 - 04 - Attachment C - Familial Statement.pdf
PDF 13 KB Posted
- Attached to
- GISD New Building Fiber RFP
- Solicitation number
- RFP GIS 190000001564 2
- Issued by
- Genesee County, Flint City, Michigan
About this file
This is a Familial Relationship Disclosure Statement form required by the Genesee Intermediate School District (GISD) in Flint, Michigan, pursuant to Public Act 232 of 2004. The document serves as a mandatory submission requirement for all bids submitted in response to the GISD New Building Fiber 2019 project. Bidders must provide a sworn and notarized statement disclosing any familial or business relationships between the bidder's employees and members of the GISD Board of Education, the District Superintendent, or any other District official. The form requires the contractor or vendor to identify themselves, provide contact information, and detail any relevant relationships that may exist between their organization and District personnel.
Bids submitted without the completed and notarized familial relationship disclosure statement will be rejected and deemed non-responsive. The statement must be acknowledged before a notary public and include the notary's signature, commission expiration date, and the county in which the acknowledgment took place. This disclosure requirement is a mandatory compliance measure designed to ensure transparency and prevent conflicts of interest in the bidding process for the District's fiber infrastructure project.
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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 .