*Does any UR Medicine Home Care (URMHC) employee, or a close relative or member of his or her household, who has or will participate in the decision to acquire goods and/or services from your company (1) own 5% (or more) stock or other interest in your company (2) serve as an officer, director, employee, proprietor, partner, trustee, or consultant of your company; (3) stand to profit financially or personally in any way from the acquisition by the University of goods and/or services from your company; or (4) receives compensation in any form or in any amount from your company?
*Any situation where a University of Rochester staff or its affiliates, faculty or student and/or his or her spouse or emancipated and /or minor children has a connection to the above referenced supplier.
If you answered yes, please complete the following section:
Under 15 U.S.C. 645(d), any person who misrepresents its size status shall (1) be punished by a fine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.