Laserfiche WebLink
<br />o <br /> <br />o <br /> <br />o <br /> <br />SECTION 20 <br />DISPUTE DISCLOSURE FORM <br /> <br />20.1. Has you finn 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 />20.2. Has your finn, or any member of your finn, been declared in default, tenninated or removed from a contract <br />or job related to the service{l Jour finn provides in the regular course of business within the last five (5) years? <br />YES NO X <br /> <br />20.3. Has your finn had against it or filed any requests for equitable adjustment, contract claims, Proposal <br />protests, or litigation in the past fIVe (5) years that is related to the services your finn provides in the regular course of <br />business? <br /> <br />YES NO X If yes, state the nature of the request for equitable adjustment, contract claim, <br />litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the monetary <br />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 <br />Proposal for the City of Sunny Isles Beach, RFP No. 08-07-01, Emergency Debris Clearing and Removal Operations. <br /> <br />Crowder Disaster Recovery <br />Firm <br /> <br /> <br />~~~ <br /> <br />~ -//-Og' <br />Date <br /> <br />Joe Blanchard, Division Director <br />Print or Type Name and Title <br /> <br />END OF SEcnON <br /> <br />77 <br />