Dispute_Disclosure_10-4-11.pdf
PDF 10 KB Posted
- Attached to
- Contact Quality Monitoring
- Solicitation number
- PR8243
- Issued by
- Florida
About this file
This document is a Dispute Disclosure form designed to capture a firm's historical contract and regulatory compliance information. The form requires a firm to disclose any reprimands, suspensions, contract defaults, terminations, or legal actions related to their business services within the past five years by marking "YES" or "NO" to three specific questions. If a "YES" response is selected, the firm must provide detailed explanation about the nature of the incident, including a brief case description, outcome or status, and any monetary amounts or contract time extensions involved.
The form includes a certification statement where the firm acknowledges that any misstatement or falsification of facts will result in forfeiture of rights for further project consideration. The document provides designated signature lines for the firm's name, date, authorized signature, officer title, and printed or typed name, indicating this is a formal legal disclosure intended to provide transparency about the firm's professional history and potential past contractual issues.
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Other files
| File | Type | Posted |
|---|---|---|
| 8243_Letter_of_Intent_to_Award.pdf | ||
| ADDENDA_ACKNOWLEDGEMENT.pdf | ||
| Addenda_No._1_8243_OQ_Contract_Quality_Monitoring.pdf | ||
| 8243_OQ_Price_Sheet.xlsx | XLSX spreadsheet | |
| Exceptions_Page_4.17.25.pdf | ||
| procure_general_services_23.pdf | ||
| RFP_8243_OQ_Contact_Quality_Monitoring.pdf | ||
| Entity_Crimes_-_Sworn_Statement_10-4-11.pdf | ||
| 8243_OQ_Attachment_C.xlsx | XLSX spreadsheet |
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Text version
DISPUTE DISCLOSURE
Answer the following questions by placing an "X" in the appropriate "YES" or "NO" box. If you answer "YES", please explain In the space provided, or via attachment.
Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years?
YES NO
Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years?
YES NO
Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business?
YES NO
If yes, state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts or extended contract time involved.
I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of this project.
Firm Date
Authorized Signature Officer Title
Printed or Typed Name
File details come from the government source that posted it. Updated .