Updated Familial Disclosure Form ERate EUP Erate Consortium.docx
DOCX document 3 MB Posted
- Solicitation number
- RFP EUP 260000000905 7
- Issued by
- Chippewa County, Michigan
About this file
This is a Familial Disclosure Form for the Erate EUP Consortium, administered by the Educational University Partnership Intermediate School District (EUPISD) as fiduciary, pertaining to bidders seeking to provide Category 1 and Category 2 services under the E-rate program. The form requires the authorized representative of a bidding contractor to provide an affidavit confirming all familial relationships between the contractor's owners and employees and the school district's superintendent and/or board members. The affiant must verify under oath their authority to bind the contractor and their personal knowledge of any such relationships, with the understanding that the school district will rely upon these representations during the bid evaluation process.
The form must be completed by an authorized company official such as a president, vice president, chief executive officer, member, partner, or owner, and signed before a notary public in Michigan. The affiant declares that the information provided is true and accurate to the best of their knowledge and agrees to testify regarding the affidavit's contents if requested. This disclosure requirement ensures transparency in the bidding process and identifies any potential conflicts of interest or familial connections that could influence contract awards.
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Text version
Attachment A – Familial Disclosure Form AFFIDAVIT OF (insert name of affiant)
STATE OF MICHIGAN )
) SS
COUNTY OF __________________________)
____________________________________________ makes this Affidavit under oath and states as follows: (Insert name of affiant)
1. I am a/the:
❏ President ❑ Vice-President ❏ Chief Executive Officer ❑ Member ❏ Partner ❑ Owner ❏ Other (please specify)__________________________________________________ of______________________________________________________, a bidder for Erate EUP Consortium, (EUPISD fiduciary) for Cat 1 and 2.
2. 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 the employee(s) of the aforementioned contractor and the school district’s superintendent and/or board members.
3. I have the 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 transportation services.
4. I declare the above information to be true to the best of my knowledge, information and belief. I can completely and accurately testify regarding the information contained in this affidavit if requested to do so.
(Signature of affiant) (Date) Subscribed and sworn before me in ______________________________ County, Michigan on the ____ day of ______________________________, 20____.
Signature: ________________________________________________________ Printed Name: ________________________________________________________ Notary Public, State of Michigan, County of _________________________________.
My Commission expires on _______________________________________________.
Acting in the County of __________________________________________________.
File details come from the government source that posted it. Updated .