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VISYU 1 t VISC:LUSURE <br />City of Sunny Isles Beach <br />16070 Cvlli;;=A--nee <br />Sa"ny 1. 6. Bcoch FL -.3.60 <br />Telephone 13051 947-0606 Fax (3051 949 3113 <br />ViSPu ii E 17I5t.CV5uRE FuKM <br />Answer the folluvving guestiuns by placing a ",&" after "ices" or "No'. of yvu answer -Tes`, pjease <br />expjain in the space proviCetl, or on a separate sReet arwcllea to znis corm. <br />1. Has year firm or any of its officers, received a reprimand of any nature or been suspended by the <br />Department of Professional Regulation, ur any other regulatory agency or professional assocladons wiLhin Lhe IasL <br />five (a) years <br />YES NO V` <br />L. Inas your firm, or any member or your nrm neen declared in aerauk- Lerminama or re -moven rrom a <br />conEratT or jofi relaEeo to Elle services your rirm provides in the regular course of business within th- last five (5) <br />yEar�? <br />YES NO <br />3. Has your firm had awainst it or filed any requc5ts fur equitabliz adjustment, contract claim, Bid prte-5ts, <br />or litigation in the pa5t five (5) years that i5 dated to the services your firm provide -i in the regular course of <br />business? <br />TES MU it yes, state the nature of the request for -quitable adju.Amunt, contract <br />claim, litivation, or protest, and staff a brief dz5criptiun of thi cn5c, the outcome or status of the salt and the <br />monetary amounts of Winded contract time involved. <br />I heleoy ceRity LMaL all bwmmems matte are Lrue and agree and onaersEana rMar any missEatement or <br />misrepresentation of falsification of facts shall be cause for forfeiture of ri-hts fur fcrthcr cumidaration of this Bid <br />for the City of Sunny I EI Beach. <br />Firm DaLe <br />Ac orizIdignatureT Print ur Type Name and Title <br />Lul(Ca' Lian53Ca<kriug9 1miC. G or 10 <br />