1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 26-19643-KM
- Issued by
- Henderson County, Lubbock City, Texas
About this file
This is a Business Questionnaire form from the City of Lubbock, Texas, required for all potential contractors and subcontractors bidding on the North Overton Public Improvement District Landscape Maintenance and Bird Mitigation contract. The questionnaire serves as a pre-qualification document for the landscape maintenance project, which requires the selected contractor to provide all labor, tools, transportation, materials, and equipment necessary to complete work according to specifications. Bidders must submit unit pricing applicable to landscaped areas completed and accepted for maintenance. The form does not specify response dates, site visits, bidder meetings, award dates, or contract term details.
The questionnaire collects essential contractor information including business type, years in operation, and a description of materials and services offered. It includes a comprehensive series of responsibility and eligibility questions addressing past contract failures, pending litigation, debarment status, default history, arrears on contracts or debts, suspension proceedings, liquidated damages assessments, and any other disqualifying factors. All contractors must certify their qualifications and operational standing by providing printed name, title, signature of owner, and date. The form contains no pricing terms, set-asides, incumbent information, or funding source details.
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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 .