Dispute_Disclosure_10-4-11.pdf
PDF 10 KB Posted
- Attached to
- Contact Quality Monitoring
- Solicitation number
- PR8243
- Issued by
- Florida
About this file
The document is a Dispute Disclosure form designed to capture potential legal or regulatory issues for a business seeking to bid on a contract. The form requires a firm to disclose any reprimands, suspensions, contract terminations, defaults, or litigation related to their business services within the past five years. The form provides checkboxes for "YES" or "NO" responses to three specific questions about the firm's professional history, with an option to provide detailed explanations for any affirmative responses.
The form emphasizes transparency and legal compliance, with a certification statement indicating that any misstatement or falsification of facts will result in forfeiture of rights for further project consideration. The document requires the firm's authorized representative to sign and provide their printed name, officer title, firm name, and date, thus serving as a legal declaration of the firm's contractual and regulatory standing. While no specific contract details or project information are included, the form is clearly designed as a pre-qualification or risk assessment tool for potential contractors.
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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 | ||
| Dispute_Disclosure_10-4-11.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 .