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0 NNr , <br /> O�AfI <br /> A �I �= DISPUTE DISCLOSURE <br /> ® .',\;\4‘ <br /> \ h City of SunnyCIsles Aven Beach <br /> �.y mo . 18070 Collins Avenue <br /> ® `. • rzo�z.^�� Sunny Isles Beach,FL 33160 <br /> ® ' <br /> or sus ' Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • DISPUTE DISCLOSURE FORM <br /> A <br /> A 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 /> 9 19.1. 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 /> A five (5) years? <br /> A YES NO X <br /> ® 19.2. 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 /> YES NO X <br /> A <br /> ® 19.3. 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 /> ® monetary amounts of extended contract time involved. <br /> ® See Section 1 for Litigation Statement <br /> I hereby certify that all statements made are true and agree and understand that any misstatement or <br /> A 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. `I/j 1/D-° (Z <br /> 411 Firm Date <br /> ® / Dennis J. Giordano/ President <br /> ® Authorized gnature Print or Type Name and Title <br /> 0 <br /> A <br /> A <br /> A <br /> A <br /> A <br /> A <br /> A <br /> DECEMBER 28,2010 B 01 7 <br /> 0 <br />