Laserfiche WebLink
<br />C) <br /> <br />SEcnON 20 <br />DISPUTE DISCLOSURE FORM <br /> <br />20.1. Has you 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 />20.2. Has your finn, or any member of your firm, been declared in defautt, terminated or removed from a contract <br />or job related to the services your finn provides in the regular course of business within the last five (5) years? <br />YES NO x <br /> <br />20.3. Has your firm had against it or filed any requests for equnable adjustment, contract claims, Proposal <br />protests, or litigation in the past five (5) years that. i~ rela~ to the ~n;ces yo~r firm provides in the regular course of <br />business? Please see attached pend1ng 11 t1gat1on <br /> <br />YES x NO If yes, state the nature of the request for equitable adjusbnent, contract claim, <br />litigation, or protest, and state a brief description of the case, the outcome or status of the sutt and the monetary <br />amounts of extended contract time involved. <br /> <br />g <br /> <br />List <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 />DRC Emerqency Services, LLC <br />Firm <br /> <br />8-8-08 <br />Date <br /> <br />~A,&"o;.dS' ~t 1- <br />umonze Igna ure <br /> <br />--- <br /> <br />Mark Stafford <br />Print or Type Name and Title <br /> <br />END OF SECTlON <br /> <br />o <br /> <br />77 <br />