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SUNNY is<F <br /> • 0" ' e <br /> DISPUTE DISCLOSURE <br /> is+ <br /> City of Sunny Isles Beach <br /> •, `"_ �' 18070 Collins Avenue <br /> D9.�..FloR'O +"' Sunny Isles Beach,FL 33160 <br /> C'T r.;of,u,*" Telephone:(305)947-0606 Fax (305)949-3113 <br /> DISPUTE DISCLOSURE FORM <br /> • <br /> Answer the following questions by placing a "X" "Yes"Yes;, .,or "No". If you answer "Yes", please <br /> explain in the space provided, or on a separate sheet attached to this.form. <br /> 19.1. 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 I✓ <br /> 19.2. Has your firm, or any member of your firm, been declared 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 I 1 <br /> 0 <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 five (5) years that is related to the services your firm provides in the regular course of <br /> business? <br /> YES NO 1 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 /> 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 /> Turner Public Relations, Irk �C b 2CA 7-0 1- <br /> Firm Date 0 <br /> C_Art\At%A'"\\/\\Q-----\vUA Christine Turner, President �► <br /> Authorized Signature Print or Type Name and Title <br /> • <br /> 0 <br /> 0 <br /> 0 <br /> v <br /> ' <br /> 70: <br /> 10,.1( ......s.«r�t!u ,�1iv "s^}f..t Cy�t..,..'.._.:Ly`•1,' ` '• <br /> DECEMBER 28,2010 6 of 10 •%,, <br /> vi <br />