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Miami -Dade County Solicitation RTQ-00918 <br />-MiamDade County <br />Contractor Due Diligence Affidavit <br />Per MiamDade County Board of County Commissioners (BoardliStesoluti9tftirity Vendors and Contractors shall disclose the foil, <br />condition of award for any contract that exceeds one million dollars ($1,000,000) or that otherwise must be presented to the Board fo <br />(1) Provide a list of all lawsuits in the five (5) years prior to bid or proposal submittal that have been filed against the firm, its dire <br />and/or board members based on a breach of contract by the firm; include the case name, number and disposition; <br />(2) Provide a list of any instances in the five (5) years prior to bid or proposal submittal where the firm has defaulted; include <br />circumstances; <br />(3) Provide a list of any instances in the five (5) years prior to bid or proposal submittal where the firm has been debarred or rE <br />non compliance or nperformance, such as a notice to cure or a suspension from participating or bidding for contracts, whet <br />Dade County or not. <br />All of the above information shall be attached to the executed affidavit and submitted to the Procurement Contracting Officer (PCO <br />overseeing this solicitation. The Vendor/Contractor attests to providing all of the above information, if applicable, to the PCO. <br />Federal Employer <br />Contract No.: Identification Number (FEIN): <br />Contract Title: <br />Printed Name of Affiant <br />Printed Title of Affiant <br />Name of Firm <br />F <br />Address of Firm State <br />Notary-Putlgtate of <br />Notary Public lnformation <br />County of <br />Subscribed and s*oriaffmmed) before me this day of, <br />by <br />Type of identification produced <br />Signature of Notary Public <br />Signature of Affiant <br />-- <br />Date <br />-- <br />Zip Code <br />20 <br />He or she is personally known to me las produced identification <br />Print or Stamp of Notary Public Expiration Date <br />Serial Number <br />Notary Public Seal <br />5/3/2019 7:48 AM P. 15 <br />