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S�NNr.rs�s <br />DISPUTE DISCLOSURE <br />City of Sunny Isles Beach <br />',_' + • " r U670 Collin Avenue <br />TyF p�f alp <br />Sunny Isles Beach, FL 33160 <br />"OF SUN Pµ Telephone: (306) 947-0606 Fax: (305) 049.31.13 <br />DISPUTE DISCLOSURE FORM <br />Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes`, please <br />explaln in thel 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 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 . 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 />RGEN Enterprises LLC, dba Cool Water Air Conditioning 6/27/2025 <br />Firm <br />ko"ft, �afti GI2"A&— <br />Authorized Signature j <br />MEMBER 28, 2016 <br />Date <br />Ramon Genemaras, CEO <br />Print. or Type Name and Title <br />