Laserfiche WebLink
0 <br /> SUNNY is,, <br /> O '-�, A <br /> c = _ �- <br /> DISPUTE DISCLOSURE <br /> i <br /> ; � t. <br /> • City of Sunny Isles Beach <br /> ', ', ,-." 18070 Collins Avenue <br /> 4P C'''''' <br /> ',•F I Oa'O ..' Sunny Isles Beach,FL 33160 <br /> '''O.sur,►°9 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 /> 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 <br /> X <br /> 19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a <br /> • <br /> contract or job related to the services your firm provides in the regular course of business within the last five (5) <br /> years? 0 <br /> YES NO X 0 <br /> 0 <br /> 19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests, S <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. 0 <br /> Spotlight Marketing&Public Relations 10/18/2017 0 <br /> F — Date 0 <br /> DeniseArencibia pa..(4-\Qx <br /> Authoized Signature Print or Type Name and Title <br /> 0 <br /> DECEMBER 28,2010 6 Of 10 <br /> 0 , <br />