1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 26-19561-KM
- Issued by
- Henderson County, Texas
About this file
This is a Business Questionnaire form required by the City of Lubbock, Texas Purchasing and Contract Management Department for the Bell Farms Public Improvement District (PID) Landscape Maintenance Agreement solicitation. The questionnaire must be completed and submitted by all potential contractors and subcontractors listed on the Schedule of Participation. The form requires standard business identification information including the contractor's legal name, doing business as names, mailing address, telephone and fax numbers, and business type classification. Contractors must also provide the number of years in business and a brief description of materials and services to be provided.
The questionnaire includes a series of responsibility and eligibility questions designed to assess contractor qualification and past performance. Contractors must disclose whether they have failed to complete a contract; have pending litigation; have been declared not responsible; have been debarred, suspended, or proposed for debarment; have defaulted on contracts; are in arrears on any contract or debt; or have had liquidated damages or penalty provisions assessed against them. The form must be signed by the owner or authorized representative with printed name, title, and date, and serves as a prerequisite for bid consideration in this landscape maintenance contracting 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 .