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<br />. <br /> <br />"\: <br />< . <br /> <br /> <br />DISPUTE DISCLOSURE <br /> <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sonny relesBelCh, Fl 3318D <br />Telephone: (30li) 9<l7~ Fax; (305) 94~3113 <br /> <br />DISPUTE DISCLOSURE FORM <br /> <br />Answer the following questions by placing a uX" after uYes" or uNo.. If you answer "Yes', please <br />explaIn In the space provided, or on a separate sheet attached to thI. form. <br /> <br />19.1. Has your firm or any of Its officers, received a reprimand of any nature or been suspended by the <br />--- of """"7~' ~.. ""' "''''''''' .go",. -,,,,-,,,, wi"" the ,.. <br />five (5) years? <br /> <br />YES NO <br /> <br />, <br /> <br />No1 <br /> <br />YES <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 flve (5) years that Is related to the servIces your firm proVides In the regular course of <br />business? <br /> <br />YES NO Y If yes, state the nature of the request for equitable adjustment, contract <br />claim, Iltlgatlon, or p~te a brief description of the case, the outcome or status of the suit and the <br />monetary amounts of extended contract tlme Involved. <br /> <br />I hereby certify that all statements made are true and agree and understand that any misstatement or <br />m/srepresentatlon of falsiflcatlon of facts shall be cause for forfeiture of rights for further consideration of this Bid <br />for Clty of Sunn h. <br /> <br /> <br />fc9-~! c9-{J( ~ <br /> <br />ate <br /> <br />rJ... AI.... \t.t ~~ <br />. A~rlzed Slgnatu <br /> <br /> <br />- <br /> <br />DECEM8!~ 2&, 2D10 <br /> <br />r.-. ~ :.... <br />~< ~ <br />,jl ;1 :w" <br /> <br />6 017 <br />