Laserfiche WebLink
• <br /> • SUN N Yps,cr.. <br /> +E7 <. DISPUTE DISCLOSURE <br /> • ' City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> a01S3a_+.,t' Sunny Isles Beach,FL 33160 <br /> Telephone:(305)947-0606 Fax:(305)949-3113 <br /> • DISPUTE DISCLOSURE FORM <br /> • <br /> • Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please <br /> 0 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 /> • <br /> YES NO X <br /> • <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 /> • <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 /> • (see attached list)* <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 /> • <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 /> • Kimley-Hom and Associates, Inc. April 30, 2012 <br /> • Firm Date <br /> • Jerry Ingram,RE.,Senior Vice PresidentlPrincipal Associate <br /> • t riz Signature Print or Type Name and Title <br /> ® <br /> 'As required in RFQ No. 12-04-02, Kimley-Horn and Associates, Inc.has reviewed the proposed contract terms and conditions language as <br /> written and objects to the language in total since it applies to Contractor Services and not Professional Services as are being requested in the <br /> • RFQ. In a discussion with the City Attorney in 2011,he indicated it would be appropriate to object to this language in total and that,if selected, <br /> ® Kimley-Hom would be provided the opportunity to provide the Professional Services using appropriate contract terms.Therefore,if selected <br /> again,we reserve the right to negotiate for a professional services contract similar in wording to the contracts that have been mutually <br /> ® acceptable to all parties in the past. <br /> • <br /> •• <br /> ® DECEMBER 28.2010 6 of 7 <br /> • <br />