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..77 DISPUTE DISCLOSURE <br />City of Sunny Isles Beach <br />15070 Collins Avenue <br />' • �' ����`�s .' Sunny Isles Beach, FL 33160 <br />'rJapheee (305)947-0606 Fes; (305)949-3113 <br />DISPO i! E 0I31LOSURE FuRM <br />Answer the following questions by placing a 'X" after Yes` or "No". If you answer "Yes", please <br />exYlain 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 assodadon5 within the last <br />five (5) years? <br />YES NO <br />2. Has your firm, or any member of your Iirm been declared In aefauk terminated or lemovea nom a <br />contratT or job related to the Services your firm provides In tele regular course or Business within the IaSt rive (5) <br />years <br />YE..) Idv <br />s. Mas your firm Hat] agalnst it or filet] any requemTor equitable ad;ustment, contract 4laims. Bid protests, <br />or Ilugadon In Erie past rive t5) years that Is related to the services ,our firm provides in the regular course of <br />Business? <br />>rE5 NO If yes, state the natur of the request for equitable adjustment, contract <br />claim litigation, or protest, and State a brief description of the ca3e, the outcome or status of the suit and the <br />moneta- amounts of extcndcd contract time involved. <br />I hereby mrtiry 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 />WC�- -�) GLL lC <br />Firm <br />AuthotlzieAignature <br />Date <br />y <br />Print or I ype Dame and I Ide <br />6 01 10 <br />Lukes' Landaraping, InC. <br />