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9 yu�wr 7trf <br />•nom; n DISPTJTE.. I71.SCLOSURE <br />V T <br />City of Sunny Isles Beach <br />' ••' 10070 (;# linS hvgnyg <br />"r"P X31.,0 ` Sunny Isles Baer, FL 33150 - <br />`' Tela phone: (305) 347-0606 Fax: (305) 999-3113 <br />DISPUTE DISCLOSURE FORM <br />Answer the following questions by placing a "X after "Yes" o: "No". If you answer "Yes", please <br />explain in tlhe space proviided, or on a separate sheet attached to this farm. <br />1. Has your rirm or any of its officers, received a reprimand of any nature or been suspended by the <br />Department of Professional Regulations or any other regulatory agency or professional associations within the last <br />five (5) years? <br />YES NO X <br />Z. Has your frrm, or any member of your term, been declared in default, terminated or removed from a <br />contract or job related to the services your firm provides in the regular course of business within tfie last five (5) <br />years? <br />YES NO <br />3. Has your firm had against it or filed any requests For equitable adjustment, contract claims, Bid protests, <br />or litigadon in the past five (5) years that is related to the services your Firm provides in the regular course of <br />business? <br />YES X NO If yes, state the nature of the request for equitable adjustment, contract <br />claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the <br />monetary amounts of extended contract time involved, Litigation summary Attached <br />I hereby certify that all statements made are true and agree and under5tand that any misstatement or <br />misrepresentation of falsification of facts shall be cause for forfeiture of rights fog further consideration of this Bid <br />For the -City of Sunny Isles Beach. <br />GrowderGulf Joint Venture, Iris. 05/07/2018 <br />FirX <br />pate <br />John Ramsay, President & CEO <br />nature Print or Type fame and Title <br />�1-; <br />i. <br />e <br />a Of 10 <br />