3-Form 6 - Litigation Disclosure.pdf

172 KB Posted

Attached to
Airport Common Use Passenger Processing System (CUPPS)
Solicitation number
025-26-AIR-RFP
Issued by
Cameron County, Texas

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This is a Litigation Disclosure Form (Form 6) required by the City of Brownsville's Procurement Department for the Airport Common Use Passenger Processing System (CUPPS) project at Brownsville South Padre Island International Airport in Texas. The form mandates that all respondents disclose any litigation, arbitration, or claims—whether pending, settled, or closed—occurring within the past five years involving the respondent, its officers, or principals that relate to performance of public contracts or professional services similar to those being solicited. The form provides two disclosure options: respondents may indicate they have not been involved in any such litigation, arbitration, or claims within the specified timeframe, or they may detail one or more matters by providing the case title and parties, case number and venue, a brief description of the dispute, and the status, outcome, and resolution date.

Respondents must certify under penalty of perjury, pursuant to Texas Penal Code Section 37.10, that the information provided is complete and accurate to the best of their knowledge and that no additional litigation, arbitration, or claims exist beyond those disclosed. False, incomplete, or misleading information may result in disqualification from the procurement process, termination of any awarded contract, or criminal prosecution. The certification requires the respondent's authorized representative to provide their signature, printed name, title, date, company name, and phone number on the form.

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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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