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<br />DISPUTE DISCLOSURE
<br />City of Sunny Isles Beach
<br />18070 Collins Avenue
<br />Sunny Isles Beach, FL 33160
<br />Telephone: (305) 947-0606 Fax: (305) 949-3113
<br />DISPUTE DISCLOSURE FORM
<br />Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please
<br />explain in the space provided, or on a separate sheet attached to this form.
<br />1. Has your firm 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 />2. Has your firm, or any member of your firm, 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 the last five (5)
<br />years?
<br />J
<br />YES NO X
<br />3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests,
<br />or litigation 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 />j monetary amounts of extended contract time involved.
<br />I hereby certify that all statements made are true and agree and understand that any misstatement or
<br />misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid
<br />for the City of Sunny Isles Beach.
<br />Calvin, Giordano & Associates, Inc,
<br />Firm �?
<br />A t ature
<br />June 28, 2022
<br />Date
<br />Chris Giordano, MSC, CCM, President
<br />Print or Type Name and Title
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<br />DISPUTE DISCLOSURE
<br />City of Sunny Isles Beach
<br />18070 Collins Avenue
<br />Sunny Isles Beach, FL 33160
<br />Telephone: (305) 947-0606 Fax: (305) 949-3113
<br />DISPUTE DISCLOSURE FORM
<br />Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please
<br />explain in the space provided, or on a separate sheet attached to this form.
<br />1. Has your firm 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 />2. Has your firm, or any member of your firm, 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 the last five (5)
<br />years?
<br />J
<br />YES NO X
<br />3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests,
<br />or litigation 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 />j monetary amounts of extended contract time involved.
<br />I hereby certify that all statements made are true and agree and understand that any misstatement or
<br />misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid
<br />for the City of Sunny Isles Beach.
<br />Calvin, Giordano & Associates, Inc,
<br />Firm �?
<br />A t ature
<br />June 28, 2022
<br />Date
<br />Chris Giordano, MSC, CCM, President
<br />Print or Type Name and Title
<br />6of8
<br />�; 80
<br />
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