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sorANY is<, <br /> A. DISPUTE DISCLOSURE <br /> ® • City of Sunny Isles Beach <br /> _ 18070 Collins Avenue <br /> ® LFCD9).FLop\o4+`' Sunny Isles Beach,FL 33160 <br /> OF SOS Telephone:(305)947-0606 Fax:(305)949-3113 <br /> DISPUTE DISCLOSURE FORM <br /> ® Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please <br /> explain in the space provided, or on a separate sheet attached to this form. <br /> 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 /> ® YES NO X <br /> 0 <br /> 2. Has your firm, or any member of your firm, been dedared 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 /> 0 <br /> YES NO X <br /> ® 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 /> ® YES NO X 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 /> 0 <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 /> ® SFM SERVICES, INC. C// <br /> 0— ��—t.1 <br /> ® Firm Date <br /> .404 CHRISTIAN INFANTE <br /> o Authorized Sig' PPPi4-r- Print or Type Name and Title <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> O 6of10 <br />