Reso 2015-2469 - Laserfiche WebLink

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• • • = -:- DISPUTE DISCLOSURE ? r n • i Vt 1' _ \ City of Sunny Isles Beach • -•.\ 18070 Collins Avenue h� - p,- s. '•«o"� +• Sunny Isles Beach.FL 33160 ® c'''o. s v s''o Telephone:(305)947-0606 Fax:(305)949-3113 • • DISPUTE DISCLOSURE FORM 0 Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please • explain in the space provided, or on a separate sheet attached to this form. O i 19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the • Department of Professional Regulations or any other regulatory agency or professional associations within the last five (5) years? • • YES NO "" • • 19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) • years? • YES NO "" • . • 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 ourse of business? • YES NO " If yes, state the nature of the request for equitable adjustment, contract claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the • monetary amounts of extended contract time involved. . • ® I hereby certify that all statements made are true and agree and understand that any misstatement or • misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid for the City of Sunny Isles Beach. /� 1� • Stockton Maintenance Group 7S 7`�J • Firm Date , • ` V■10-.- Doug Riordan Sole owner / President • Authorized Signature Print or Type Name and Title • • • • • • • • • DEGEIMER 28.2010 . 6 of 10