1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 26-19436-KM
- Issued by
- Hunt County, Texas
About this file
This is a Business Questionnaire form issued by the City of Lubbock, Texas Purchasing and Contract Management department for use by all potential contractors and subcontractors seeking to participate in city procurement opportunities, specifically related to Operations and Maintenance of Baggage Handling System. The questionnaire requires prospective contractors to provide basic business information including company name, business address, telephone and fax numbers, business type classification, and years in operation. Contractors must also provide a brief description of the materials and services they offer and indicate whether their business operates as a subsidiary of another entity.
The questionnaire includes a comprehensive compliance and responsibility certification section requiring contractors to disclose any history of contract non-completion, pending litigation, debarment or suspension status, default history, payment arrears, liquidated damages assessments, and any proceedings related to business responsibility or qualification to receive public contracts. Contractors must affirm their responsibility status by answering yes or no to eighteen distinct compliance questions covering prior performance issues, government enforcement actions, and disqualification events. The form requires certification by printed name, title, signature of owner, and date of submission.
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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 .