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