3-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 25-19282-MA Ultrasonic Meters, Products & Services
- Issued by
- Hunt County, Texas
About this file
This document is a Business Questionnaire form required by the City of Lubbock, Texas for all potential contractors and subcontractors participating in contract opportunities. The questionnaire is a standardized disclosure document designed to collect essential information about prospective vendors, including their business name, mailing address, telephone and fax numbers, and business structure (individual, corporation, partnership, or joint venture). The form requests a description of the materials and services the business proposes to provide in connection with the City's Request for Proposals 25-19282-MA for ultrasonic water meters and related products and services.
The questionnaire includes a comprehensive series of qualification and responsibility questions requiring yes or no responses regarding the contractor's business history and standing. These questions address critical factors such as prior contract completion, pending litigation, debarment or suspension status, default history, arrears on existing contracts or debts, and assessment of liquidated damages or penalties. The form requires certification by an owner or authorized representative through printed name, title, signature, and date, ensuring accountability and legal validity of the submitted responses. This questionnaire serves as a pre-qualification mechanism to verify that contractors meet the City's standards for responsibility and eligibility to perform public contracting work.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2-06 - Reference Form.pdf | ||
| 7-01 - RFP 26 19282 MA Ultrasonic Meters and AMI Fire Hydrant Meters.docx | DOCX document | |
| 1-04 - Non Collusion Affidavit.pdf | ||
| 6-02 - Vendor Acknowledgement Form.docx | DOCX document | |
| 4-03 Insurance Affidavit.pdf | ||
| 5-07 - Contact Person Form.pdf |
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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 .