1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Attached to
- Airport Terminal Advertising Concessions
- Solicitation number
- RFP 26-19432-KM
- Issued by
- Hunt County, Texas
About this file
This is a Business Questionnaire form required by the City of Lubbock, Texas Purchasing and Contract Management department for all potential contractors and subcontractors bidding on the Airport Terminal Advertising Concessions opportunity. The questionnaire is a mandatory submission document that gathers essential business information including company name, business address, telephone and fax contact details, business type classification, and years of operation. Contractors must also provide a brief description of their materials and services relevant to the advertising concessions contract.
The questionnaire includes a comprehensive set of eligibility and responsibility questions designed to assess contractor qualifications and history. Respondents must disclose whether the business is a subsidiary entity, has failed to complete previous contracts, has pending litigation, has been declared "not responsible," has been debarred or suspended from government contracting, has defaulted on contracts or surety agreements, is in arrears on debts, has pending responsibility or debarment proceedings, or has faced liquidated damages or penalties for failure to complete work on time. The form requires certification by the business owner or authorized representative through printed name, title, signature, and date, serving as the primary vetting mechanism to ensure only qualified and responsible contractors are considered for this City of Lubbock concessions opportunity.
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Text version
City of Lubbock, TX
Purchasing and Contract Management
Business Questionnaire
This questionnaire must be submitted for all potential Contractors and subcontractors listed on the
Schedule of Participation.
1. Name of Proposed Contractor ("Business", herein):
Doing Business As:
(other business name, if applicable)
2. Business Mailing Address:
Street Address
City State Zip Code
3. Business Telephone Number: ( ) Fax Number: ( )
4. Business Type: Individual Corporation Partnership Joint Venture
5. Number of Years in Business:
13. Please provide a brief description of your materials and/or services:
14. Is the Business a subsidiary of another entity? Yes No
15. Has the Business, or any officer or partner thereof, failed to complete a contract? Yes No
16. Is any litigation pending against the Business? Yes No
17. Has the Business ever been declared "not responsible"? Yes No
18. Has the Business been debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded or otherwise disqualified from bidding, proposing or contracting? Yes No
19. Has the Business been a defaulter, as principal, surety or otherwise? Yes No
20. Has the government or other public entity requested or required enforcement of any of its rights under a surety agreement on the basis of a default or in lieu of declaring the Business in default?
Yes No
21. Is the Business in arrears upon a contract or debt? Yes No
22. Are there any proceedings pending relating to the Business' responsibility, debarment, suspension, voluntary exclusion or qualification to receive a public contract? Yes No
23. Have liquidated damages or penalty provisions been assessed against the Business for failure to complete the work on time or for any other reason? Yes No
Printed Name: Title
Signature of Owner: Date:
File details come from the government source that posted it. Updated .