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• <br /> El <br /> O�SUMNY,$14.4 <br /> ` -5.- 0 DISPUTE DISCLOSURE <br /> ~ • r n <br /> •: City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> a ' <br /> °• ''•r I off' +* Sunny Isles Beach,FL 33160 <br /> �'' „,,N�` Telephone:(305)947-0606 Fax:(305)949-3113 <br /> 1 DISPUTE DISCLOSURE FORM <br /> • Answer the following questions by placing a "X after "Yes" o: "No". If you answer "Yes", please <br /> Iexplain 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 /> 1 <br /> 2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a <br /> a contract or job related to the services your firm provides in the regular course of business within the last five (5) <br /> years? <br /> YES NO X <br /> I. • <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 X NO If yes, state the nature of the request for equitable adjustment, contract <br /> Q 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. Litigation Summary Attached <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 /> CrowderGulf Joint Venture, Inc . . 05/07/2018 <br /> UFirmf,, Date . <br /> 7/ <br /> �/ John Ramsay, President & CEO <br /> 11 j• orized Signature Print or Type Name and Title <br /> • <br /> fi . <br /> 0 <br /> I <br /> 11 . <br /> 6 of 10 <br />