2-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Attached to
- Landscape & Grounds Maintenance Services for North, South and East Patrol Division Stations.
- Solicitation number
- RFP 26-19638-SR
- 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 all potential contractors and subcontractors participating in the Landscape & Grounds Maintenance Services contract opportunity. The questionnaire must be completed and submitted as part of the proposal process for landscaping and grounds maintenance services to be provided at three Lubbock Police Department Patrol Division Stations: North Station (5910 Erskine St.), South Station (14005 Indiana Ave.), and East Station (1901 MLK Jr. Blvd.). The services include grounds maintenance, litter control, plant and tree maintenance, and structural and site cleanliness at these designated locations.
The questionnaire requests comprehensive business information including company name, business address, contact information, business type, and years in operation, along with a description of materials and services offered. The form includes a mandatory qualification verification section requiring contractors to disclose any history of contract non-completion, pending litigation, debarment or suspension status, default history, government enforcement actions related to surety agreements, payment arrears, responsibility proceedings, and assessed liquidated damages or penalties. All responses must be signed and dated by the business owner, with the form serving as a critical compliance and vetting document to establish contractor responsibility and eligibility to perform work for the City of Lubbock.
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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 .