3-05 - Business Questionnaire.pdf
PDF 13 KB Posted
- Solicitation number
- RFP 26-19418-KM
- 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 the Body Work & Accident Damage Repair for Citibus Vehicles contract. The questionnaire serves as a prequalification document for contractors seeking to provide paint and body repair services for transit vehicles, including accident repairs, vehicle paint services, and common body repairs for transit buses, vans, and relief vehicles. The form requires contractors to provide basic business information including legal name, doing business as names, mailing address, telephone and fax numbers, and business type classification. Contractors must also document the number of years in business and provide a brief description of materials and services offered.
The questionnaire includes a comprehensive responsibility and qualification screening section requiring contractors to disclose any adverse business history, including failed contracts, pending litigation, debarment or suspension status, default history, payment arrears, and any assessed liquidated damages or penalties. All responses must be certified by the business owner or authorized representative through signature and date. The form requires disclosure of subsidiary relationships and any proceedings pending related to business responsibility or qualification to receive public contracts, ensuring that only qualified and responsible contractors proceed to contract award consideration.
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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 .