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<br />. <br /> <br />SECTION 20 <br />DISPUTE DISCLOSURE FORM <br /> <br />20.1. Has you 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 /> <br />YES <br /> <br />NO <br /> <br />x <br /> <br />20.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract <br />or job related to the services your firm provides in the regular course of business within the last five (5) years? <br />YES NO x <br /> <br />20.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Proposal <br />protests, 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 /> <br />YES NO x If yes, state the nature of the requesl for equitable adjustment, contract claim, <br />litigation, or protest, and state a brief description of the case, lhe outcome or status of the suit and lhe monetary <br />amounts of extended contract time involved. <br /> <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 <br />Proposal for the City of Sunny Isles Beach, RFP No. 08-07-01, Emergency Debris Clearing and Removal Operations. <br /> <br /> <br />Auqust 12th, 2008 <br />Date <br /> <br />Samuel LoBue, President <br />Print or Type Name and Title <br /> <br />END OF SECTION <br /> <br />77 <br />