1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Attached to
- Automated Teller Machine Services
- Solicitation number
- RFP 26-19502-KM
- Issued by
- Hunt County, Texas
About this file
This is a Business Questionnaire form issued by the City of Lubbock, Texas, for use by all potential contractors and subcontractors bidding on municipal contract opportunities. The questionnaire requires submission of basic business information including the company name, business address, telephone and fax contact details, and business type classification. Prospective contractors must identify the number of years in operation and provide a brief description of materials and services offered. The form does not specify particular project details, quantities, response deadlines, site visits, or bidder conferences, as it serves as a standardized pre-qualification document applicable across multiple City of Lubbock procurement opportunities, including the related Automated Teller Machine Services solicitation.
The questionnaire contains an extensive compliance verification section requiring contractors to disclose any history of contract failures, pending litigation, debarment or suspension status, default proceedings, arrears on contracts or debts, liquidated damages assessments, or questions regarding business responsibility and qualification to receive public contracts. All responses must be signed by the business owner or authorized representative with printed name, title, and date. The form does not address pricing terms, set-asides, incumbent information, or funding sources, as these elements are contained within individual solicitation documents rather than the general business questionnaire used for contractor pre-qualification and eligibility determination.
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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 .