3-Form 6 - Litigation Disclosure.pdf

172 KB Posted

Attached to
Coffee Road Roadway Drainage and Utility Improvements
Solicitation number
005-26-EPW-IFB
Issued by
Cameron County, Texas

About this file

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The document is a Litigation Disclosure Form (Form 6) issued by the Procurement Department of the City of Brownsville for Fiscal Year 2026, Version 2. The form requires potential respondents to disclose any litigation, arbitration, or claims involving the respondent, its officers, or principals related to public contracts or services within the past five years. Respondents must either indicate they have no such litigation or provide detailed information about any legal matters, including case title, case number, court venue, a brief description of the dispute, and its current status or outcome.

The form emphasizes the importance of complete and accurate disclosure, with a clear warning that submitting false, incomplete, or misleading information may result in serious consequences, including disqualification, contract termination, or potential prosecution under Texas Penal Code § 37.10 for tampering with a governmental record. The document includes spaces for the respondent's signature, printed name, title, date, company name, and phone number, providing a comprehensive template for litigation history reporting in the procurement process.

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FY26 – Version 2 Procurement Department October 2025

Form 6 – Litigation Disclosure

Purpose

This form requires each Respondent to disclose any litigation, arbitration, or claims—pending, settled, or closed—within the past five (5) years involving the Respondent, its officers, or principals that relate to performance of public contracts or services similar to those solicited by the City of Brownsville.

Disclosure Statement

☐ The Respondent has NOT been involved in any litigation, arbitration, or claim within the past five (5) years related to public contracting or professional services.

☐ The Respondent HAS been involved in one or more litigation, arbitration, or claim matters within the past five (5) years as described below:

Case Title / Parties Case No. / Court / Venue Brief Description of Dispute

Status / Outcome / Date Resolved

Attach additional pages if necessary.

Certification

By signing below, the undersigned Respondent certifies that the information provided herein is complete and accurate to the best of their knowledge and that no other litigation, arbitration, or claims exist except as disclosed above. The Respondent acknowledges that submission of false, incomplete, or misleading information may result in disqualification, termination of contract, or prosecution under Texas Penal Code § 37.10 (Tampering with a Governmental Record).

Signature: ____________________________________________

Printed Name: _________________________________________

Title: ________________________________________________

Date: ______________________

Company Name: ________________________________________

Phone: ______________________

The Respondent has NOT been involved in any litigation arbitration or claim within the past five 5 years: Off
The Respondent HAS been involved in one or more litigation arbitration or claim matters within the past: Off
Case Title PartiesRow1:
Case No Court VenueRow1:
Brief Description of DisputeRow1:
Status Outcome Date ResolvedRow1:
Case Title PartiesRow2:
Case No Court VenueRow2:
Brief Description of DisputeRow2:
Status Outcome Date ResolvedRow2:
Case Title PartiesRow3:
Case No Court VenueRow3:
Brief Description of DisputeRow3:
Status Outcome Date ResolvedRow3:
Case Title PartiesRow4:
Case No Court VenueRow4:
Brief Description of DisputeRow4:
Status Outcome Date ResolvedRow4:
Case Title PartiesRow5:
Case No Court VenueRow5:
Brief Description of DisputeRow5:
Status Outcome Date ResolvedRow5:
Case Title PartiesRow6:
Case No Court VenueRow6:
Brief Description of DisputeRow6:
Status Outcome Date ResolvedRow6:
Printed Name_6:
Title_7:
Date_6:
Company Name_6:
Phone_6:
Signature6_es_:signer:signature:

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