proc_dispute_disclosure_form_1.pdf
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- Attached to
- 2025 & 2026 Emergency Line Clearance
- Solicitation number
- PR8325
- Issued by
- Florida
About this file
The document is a Dispute Disclosure Form for a state and local contract opportunity related to emergency line clearance services in Florida. The form requires a potential contractor to disclose any professional reprimands, contract defaults, suspensions, or litigation history within the past five years that might impact their eligibility for the 2025 & 2026 Emergency Line Clearance project involving storm restoration tree and vegetation line clearance services along transmission and distribution rights of way.
The form is designed to ensure transparency and evaluate a firm's professional conduct and reliability. By requiring detailed disclosure of any regulatory actions, contract terminations, or legal disputes, the document allows the procuring agency to assess potential risks associated with awarding the contract. Firms must accurately complete the form, understanding that any misstatement or falsification could result in forfeiture of contract consideration. The form includes checkboxes for reporting disciplinary actions, contract defaults, and litigation, with space for additional explanatory details if any of these events have occurred.
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Text version
DISPUTE DISCLOSURE for Solicitation #:_____________
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
Dispute Disclosure Form_v.1_160708
| DISPUTE DISCLOSURE for Solicitation: |
| association within the last five 5 years: Off |
| business within the last five 5 years: Off |
| regular course of business: Off |
| Firm: |
| Printed or Typed Name: |
| Date: |
| Officer Title: |
File details come from the government source that posted it. Updated .