1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 26-19659-KM
- Issued by
- Henderson County, Texas
About this file
This is a Business Questionnaire form issued by the City of Lubbock, Texas Purchasing and Contract Management department that must be completed by all potential contractors and subcontractors for the 457(b) Deferred Compensation Plan recordkeeping and administration contract opportunity. The questionnaire requires submission of basic business information including the contractor's legal name, doing business as designation, mailing address, telephone and fax numbers, and business type classification. Contractors must also indicate the number of years in business and provide a brief description of materials and services offered.
The questionnaire includes a comprehensive compliance and responsibility section requiring contractors to disclose any history of contract non-completion, pending litigation, debarment or suspension status, default history, arrears on contracts or debts, prior assessment of liquidated damages or penalties, and any proceedings relating to business responsibility or qualification to receive public contracts. Additionally, contractors must disclose whether their business is a subsidiary of another entity. The form requires certification by the owner or authorized representative through printed name, title, signature, and date, ensuring accountability and accuracy of all submitted information.
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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 .