3-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Attached to
- Landscape & Grounds Maintenance Services Patrol Division Station South - 14005 Indiana Ave.
- Solicitation number
- RFP 26-19365-SR
- Issued by
- Hunt 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 bidding on government contracts. The questionnaire applies to the Landscape & Grounds Maintenance Services contract for the Lubbock Police Department Patrol Division Station South located at 14005 Indiana Ave. Prospective contractors must submit this form as part of their proposal process. The project requires grounds maintenance, litter control, plant and tree maintenance, and site cleanliness services. A mandatory site visit is required for interested bidders, with reservations available by calling 806-775-2171 or emailing SairaRivera@mylubbock.us.
The questionnaire collects essential contractor information including business name, address, contact details, business type, and years in operation, along with a description of materials and services offered. Contractors must disclose whether they are subsidiaries of other entities and provide detailed responses regarding contract completion history, litigation, debarment status, default history, payment arrears, and any assessed liquidated damages or penalties. The form requires the signature and date of the business owner or authorized representative, serving as a certification of the accuracy and truthfulness of the provided information. This questionnaire functions as a responsibility and eligibility screening tool to ensure only qualified contractors proceed in the bidding process.
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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 .