1-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Attached to
- Upland Crossing Public Improvement District (PID) Playa Lake Stormwater Drainage Restoration
- Solicitation number
- RFP 26-19456-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 for the Upland Crossing Public Improvement District (PID) Playa Lake Stormwater Drainage Restoration project. The questionnaire must be submitted by all potential contractors and subcontractors listed on the Schedule of Participation. The project involves restoring the drainage area at Playa Lake Park, located at 7335 26th Street, Lubbock, Texas 79407, to the original cut-fill model and compacting soil around all drainage channels to prevent further erosion.
The Business Questionnaire collects essential information from contractors including company name, business address, telephone and fax numbers, business type classification, and years in operation. The form requires contractors to disclose materials and services offered and includes a comprehensive section of yes-or-no questions designed to assess contractor responsibility and eligibility. These questions address critical compliance matters such as contract completion history, pending litigation, debarment status, default history, arrearages on contracts or debts, suspension proceedings, and any assessed liquidated damages or penalties. All responses must be signed and dated by the business owner or authorized representative, establishing accountability for the accuracy of 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 .