Statement of Familial Relationship_10-PVan.docx
DOCX document 23 KB Posted
- Attached to
- 10-Passenger Van
- Solicitation number
- RFQ LCAS 260000000479 4
- Issued by
- Michigan
About this file
This is a Statement of Familial Relationship form required by Lake City Area Schools for bidders submitting proposals on a 10-Passenger Van procurement in Michigan. The form serves as a disclosure document wherein bidders must identify any familial relationships between the contractor's owners or employees and the school district's superintendent and/or board members. Bidders are required to either list all such relationships in the designated table, providing the employee or owner name, the related party, and the nature of the relationship, or certify that no familial relationships exist. The form must be completed by an authorized representative of the bidding firm, notarized, and submitted with the bid.
The document is a compliance and transparency mechanism designed to identify potential conflicts of interest prior to bid evaluation and award. Completion of this form is mandatory for bid consideration, and the bidder's authorized signatory is required to affirm under penalty of perjury that the information provided is complete and accurate. The notarization requirement adds an additional layer of verification to ensure the integrity of the disclosure process.
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Other files
| File | Type | Posted |
|---|---|---|
| Corrected VIN.pdf | ||
| 10-Passenger Van RFQ.pdf | ||
| Scanned from a Xerox Multifunction Printer.pdf | ||
| IMG_0082.jpeg | JPEG file | |
| IMG_0104.HEIC | HEIC file | |
| IMG_0080.jpeg | JPEG file | |
| IMG_0083.jpeg | JPEG file | |
| IMG_0081.jpeg | JPEG file | |
| IMG_0105.HEIC | HEIC file |
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Text version
Lake City Area Schools
STATEMENT REGARDING FAMILIAL RELATIONSHIP
| I am the | of | , a bidder on a |
| (Title) | (Company Name) |
10-Passenger Van for Lake City Schools.
____ 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 employee(s) of the aforementioned contractor and the school district's superintendent and/or board members.
The following are the familial relationship(s):
Owner I Employee Name Related to: Relationship
1.
2.
3.
4.
5.
(Attach additional pages if necessary to disclose familial relationships)
I have authority to bind the aforementioned contractor with the representations contained herein, and I am fully aware that the school district will rely on my representations in evaluating bids for the construction project.
____ There is no familial relationship that exists between the owner(s) and employee(s) of the aforementioned contractor and the school district's superintendent and/or board members.
| BIDDER 'S FIRM NAME | BY (SIGNATURE) | PRINTED NAME AND TITLE | |
| Subscribed and sworn before me, this | Seal: |
day of ,20___, a Notary Public In and for County, MI
Signature
My commission expires
Statement of Familial Relationship - 1 of 1
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