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DISPUTE DISCLOSURECity of Sunny Isles Beach18070 Collins AvenueSunny Isles Beach, FL 33160Telephone: (305) 947-0606 Fax: (305) 949-3113DISPUTE DISCLOSURE FORMAnswer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", pleaseexplain in the space provided, or on a separate sheet attached to this form.19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by theDepartment of Professional Regulations or any other regulatory agency or professional associations within the lastfive (5) years?YESNOJL19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from acontract or job related to the services your firm provides in the regular course of business within the last five (5)years?YESNO_x.19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims. Bid protests,or litigation in the past five (5) years that is related to the services your firm provides in the regular course ofbusiness?YESNOJLIf yes, state the nature of the request for equitable adjustment, contractclaim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and themonetary amounts of extended contract time involved.I hereby certify that all statements made are true and agree and understand that any misstatement ormisrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bidfor the City of Sunny Isles Beach.Nabors. Giblin & Nickerson. P.A.Firm''^QiA ' ^ 73^AuUiorized SignatureMarch 4.2019DateEdward A. Dion. ShareholderPrint or Type Name and TitleDECEMBER 28. 2010