DISPUTES_DISCLOSURE_FORM1.pdf
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- Attached to
- Airport General Engineering Consultant
- Solicitation number
- RFQ-019-2022
- Issued by
- Clay County, Florida
About this file
The document is a Disputes Disclosure Form for the City of Lake City, Florida, related to a Request for Proposal (RFP-021-2006) for a Financial Advisor for the Lake City Gateway Airport (LCQ). The form requires potential bidders to disclose any professional regulatory reprimands, contract defaults, terminations, or legal disputes within the past five years that are related to the services being proposed.
The form emphasizes transparency and accountability, with bidders required to provide detailed information about any past issues that could impact their ability to perform the contract. By completing this form, firms certify the accuracy of their statements, understanding that any misrepresentation or falsification of facts will result in forfeiture of rights for further consideration of the proposal. The document must be included with the submittal and requires an authorized signature and firm details.
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Text version
DISPUTES DISCLOSURE FORM
Answer the following questions by placing as “X” after “YES” or “NO”. 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 Regulations 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 against it or filed any request for equitable adjustment, contract claims, bid protest, 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, litigation, or protest, and state a brief description of the case, the outcome or status of the 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 proposal for the City of Lake City, RFP-021-2006, Request for Proposal for Financial Advisor.
Firm Date
Authorized Signature and Title Printed or Typed Name and Title
THIS FORM MUST BE INCLUDED WITH YOUR SUBMITTAL
File details come from the government source that posted it. Updated .