Laserfiche WebLink
® 44 „ <br /> ® SVi '�F <br /> DISPUTE DISCLOSURE <br /> ® ` City of Sunny Isles Beach <br /> ', ,:;o�• 18070 Collins Avenue <br /> icoo• "�� Sunny Isles Beach,FL 33180 <br /> ® o, • na ' 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 /> ® 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 /> five (5)years? <br /> ® YES NO )C <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 <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 /> ® 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 /> ® Savino & Miller Design Studio 04-30-2012 <br /> ® Firm Date <br /> ® Adriana Savino-Miller, President <br /> ® Authorized Signature Print or Type Name and Title <br /> ® The project design team and general contractor are presently in litigation with the City of Miami <br /> ® Beach regarding various issues at South Pointe Park. Savino & Miller Design Studio was part of <br /> ® the design team. <br /> 410 <br /> ® DECEMBER 28,2010 6 of 7 <br /> Smarm&i Desi.n StudiooL',f 9)#12-04-02 79 <br />