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0 <br /> SUNNY IS,4EJ <br /> 0 .a.O <br /> 4-t;,-�� DISPUTE DISCLOSURE <br /> • <br /> ', City of Sunny Isles Beach <br /> 18070 Collins Avenue <br /> 1 • A ._ ,,,,. , <br /> Sf iD,,-.Lo'' ..* Sunny Isles Beach,FL 33160 <br /> C'''. Of SOS"`'o Telephone:(305)947-0606 Fax:(305)949-3113 <br /> aDISPUTE DISCLOSURE FORM <br /> Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please <br /> IIexplain 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 /> 11 five (5) years? <br /> YES NO X <br /> II <br /> 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 /> IIyears? <br /> YES NO X <br /> El <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 /> II <br /> business? <br /> YES X NO If yes, state the nature of the request for equitable adjustment, contract <br /> II 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 /> 0 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 /> 0 CrowderGulf Joint Venture, Inc. 05/07/2018 <br /> Firm Date <br /> 7/1 <br /> �/ ,,, 5; John Ramsay, President & CEO <br /> II % orized Signature Print or Type Name and Title <br /> I <br /> 1 , <br /> I <br /> 0 <br /> 6 of 10 <br />