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DISCLOSURE STATEMENT <br />Vendor must disclose any possible conflict of interest with the City of Louisville including, <br />but not limited to, any relationship with any City of Louisville elected official or employee. <br />Your response must disclose if a known relationship exists between any principal of your <br />firm and any City of Louisville elected official or employee. If, to your knowledge, no <br />relationship exists, this should also be stated in your response. Failure to disclose such a <br />relationship may result in cancellation of a contract as a result of your response. This form <br />must be completed and returned in order for your proposal to be eligible for consideration. <br />NO KNOWN RELATIONSHIPS EXIST <br />RELATIONSHIP EXISTS (Please explain relationship) <br />I CERTIFY THAT: <br />1. I, as an officer of this organization, or per the attached letter of authorization, am <br />duly authorized to certify the information provided herein are accurate and true as of <br />the date; and <br />2. My organization shall comply with all State and Federal Equal Opportunity and Non - <br />Discrimination requirements and conditions of employment. <br />3. <br />Printed or Typed Name Title <br />Signature <br />\,) <br />9 <br />