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DISCLOSURE STATEMENT <br />Vendor must disclose any possible conflict of interest with the City of Louisville <br />including, but not limited to, any relationship with any City of Louisville elected official or <br />employee. Your response must disclose if a known relationship exists between any <br />principal of your firm and any City of Louisville elected official or employee. If, to your <br />knowledge, no relationship exists, this should also be stated in your response. Failure to <br />disclose such a relationship may result in cancellation of a contract as a result of your <br />response. This form must be completed and returned in order for your proposal to be <br />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 <br />as of the date; and <br />2. My organization shall comply with all State and Federal Equal Opportunity and <br />Non -Discrimination requirements and conditions of employment. <br />Printed or Typed Name Title <br />Signature <br />25 <br />