7-Form 8 - Litigation Disclosure Form.pdf

PDF 65 KB Posted

Attached to
Purchase and Delivery of Landfill Third Truck Scale Device and Installation
Solicitation number
260-25-EPW-IFB
Issued by
Cameron County, Texas

About this file

Written by GovTribe AI ·

This document is a Litigation Disclosure form from the City of Brownsville requiring potential contractors or vendors to disclose legal and performance history. The form consists of three specific questions that must be answered by circling "YES" or "NO", covering potential legal issues within the past five to ten years, including felony/misdemeanor convictions, contract terminations, and litigation involvement with the City of Brownsville or other government/private entities.

The form warns that failure to fully and truthfully complete the disclosure may result in proposal disqualification or contract termination. If any questions are answered "YES", the respondent is required to provide detailed information on a separate page about the specific incidents, including names of individuals involved, the nature of the issue, and its current status or outcome. The form requires a signature from an authorized representative and provides space for dating the document.

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CITY OF BROWNSVILLE

LITIGATION DISCLOSURE

Respond to each of the questions below by circling the appropriate answer.

Failure to fully and truthfully disclose the information required by this

Litigation Disclosure form may result in the disqualification of your proposal from consideration or termination of the contract, once awarded.

1. Have you or any member of your Firm or Team to be assigned to this engagement ever been indicted or convicted of a felony or misdemeanor greater that a Class C in the last five (5) years?

Circle One YES NO

2. Have you or any member of your Firm or Team been terminated (for cause or otherwise) from any work being performed for the City of Brownsville or any other Federal, State or

Local Government, or Private Entity?

3. Have you or any member of your Firm or Team been involved in any claim or litigation with the City of Brownsville or any other Federal, State or Local Government, or Private Entity during the last ten (10) years?

If you have answered “YES” to any of the above questions, please indicated the name(s) of the person(s), the nature, and the status and/or outcome of the indictment, conviction, termination, claim or litigation, as applicable. Any such information should be provided on a separate page, attached to this form and submitted with your proposal.

Signature/Title of Authorized Representative

Date

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