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S,ir,Y IS <br />DISPUTE DISCLOSURE. <br />City of Sunny Isles Beach <br />r 18070 Collins Avenue <br />Sunny Isles Beach, Fl. 33160 <br />7e1Eptn6e; (305) 947-0606 6axf (301949.3113 <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 x <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 />YES - NO. x <br />19.3. Has your firm had against it or fled 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 />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 />EnviroWaste Services Group; Inc. <br />Firm <br />Authiori a Signature <br />DECEMBER 28. M 0 <br />12/09/2024 <br />pate <br />Jim.Lona. CEO <br />Print or Type Name and Tide <br />30 <br />