1-00 45 42 Small Business Utilization Form.xlsx
XLSX spreadsheet 74 KB Posted
- Solicitation number
- 26-0321
- Issued by
- Tarrant County, Texas
About this file
This Small Business Utilization Form is associated with PW 2022 Bond Year 3 Contract 18 for City Project No. 104324 in Texas. The project encompasses significant infrastructure work including approximately 6,500 linear feet of 8-inch water pipe installation via open cut, 2,000 linear feet of 8-inch sewer pipe via open cut, and 400 linear feet of 8-inch sewer pipe using alternative installation methods. The work also includes 6,500 square yards of pulverization and asphalt overlay, 7,000 square yards of concrete pavement, 20,000 square feet of concrete sidewalk, and 21,500 square feet of concrete driveway. The form documents small business participation requirements and commitments for this public works contract.
The Small Business Utilization Form establishes set-aside requirements and tracking mechanisms for small business engagement on this public works project funded through the 2022 Bond Year 3 program. The form requires contractors to identify and document their commitments to utilize small business subcontractors and suppliers throughout project execution, ensuring compliance with local small business participation goals and initiatives established by the City.
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Other files
| File | Type | Posted |
|---|---|---|
| 5-00 45 26 Contractor Compliance with Workers Compensation Law.doc | DOC document | |
| 3-104324 Bid Proposal Workbook.xlsx | XLSX spreadsheet | |
| 8-30048 CFW 2022 Yr 3 Contract 18 FINAL 09222026.pdf.pdf | ||
| 7-00 45 13 Prequalification Application.pdf | ||
| 10-104324 Contract 18 Specifications.pdf | ||
| 9-Submission Instructions - 26-0321.docx | DOCX document | |
| 2-00 45 11 Bidders Prequalifications.pdf | ||
| 6-00 11 13 Invitation to Bidders.docx | DOCX document | |
| 4-Bid Documents Package Folder Contents Checklist.pdf |
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Text version
Sheet1
| 00 45 42 | |||||
| Small Business Utilization Form | |||||
| PRIME BIDDER/OFFEROR COMPANY NAME | |||||
| PROJECT NAME: | 2022 Bond Year 3 Contract 18 | ||||
| PROJECT NUMBER: | 104324 | Total Contract $ Amount | |||
| BID DATE: | 10/15/26 | City’s Small Business Goal | Bidder/Offeror’s Commitment | ||
| Prime Bidder/Offeror is a Small Business: | No | 30 | % | ERROR:#DIV/0! | % |
| ALL SMALL BUSINESS FIRMS MUST BE CERTIFIED BEFORE BID | |||||
| DOCUMENTATION FROM AN APPROVED CERTIFYING AGENCY MUST BE PROVIDED WITH THIS FORM. | |||||
| Failure to complete this form in its entirety and submit it with the Bid/Offer may result in the bid being considered non-responsive. | |||||
| Should the City of Fort Worth determine that the Prime Bidder/Offeror is qualified for award of contract, upon execution of said contract, the undersigned Prime Bidder/Offeror shall enter into a formal agreement with the Small Business firm(s) listed in this utilization schedule. | |||||
| Small Business firms listed toward meeting the project goal must be physically located in the City's marketplace at the time of bid. | |||||
| The marketplace is Denton, Parker, Wise, Tarrant, and Johnson counties. | |||||
| Certified means those small business firms that have been certified as Small Businesses by one of the following Certifying Agencies: North Central Texas Regional Certification Agency (NCTRCA), Women’s Business Council – Southwest (WBCS), Dallas/Fort Worth Business Council (DFW BC), Texas Historically Underutilized Business (HUB) Program and Texas Unified Certification Program (TUP) DBE/ACDBE and Texas Department of Transportation (TXDOT) SBE Directory. | |||||
| Prime Bidders/Offerors are required to identify ALL subcontractors, regardless of status. Small Business Suppliers shall be identified. The Small Business supplier % should be removed from the prime/subcontractor's % that is instaling the supplied product. |
The total % of all Prime/Subcontractors and Small Business suppliers should equal 100%.
| Certified Small Business Prime/Bidder/Offeror Contractors, counting their self-performance towards meeting the contract goal, must be certified within those NAICS codes for the work it intends to perform. | ||
| The Prime Bidder/Offeror will not make additions, deletions, or substitutions to this list without the prior approval of the City of Fort Worth. Any unjustified change or deletion shall be a material breach of contract and may result in debarment. | ||
| List Prime Contractor first and Prime Contractor’s participation, expressed in dollars. Next, list certified Small Business firm names, including DBAs, as shown on their certification. Last, list non-small business firms. | ||
| NAMES AND ADDRESSES OF *PRIME CONTRACTOR* | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | Yes |
| Contact Person: | $ AMOUNT: | |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: | |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| Total Dollar Amount of Certified Prime Bidder/Offeror Services towards Small Business contract goal | $ | 0 |
| Total Dollar Amount of Prime Bidder/Offeror Services (Non- Small Business) | $ | 0.00 |
| Total Dollar Amount of Small Business Subcontractors/Suppliers | $ | 0.00 |
| Total Dollar Amount of Non-Small Business Subcontractors/Suppliers | $ | 0.00 |
| TOTAL AMOUNT BID | $ | 0.00 |
| By affixing a signature to this form, the Prime Bidder/Offeror agrees to provide, directly to the City upon request, complete and accurate information regarding actual work performed by all subcontractors. The Prime Bidder/Offeror also agrees to allow an audit and/or examination of any books, records and files held by their company. The Prime Bidder/Offeror agrees to allow an authorized officer or employee of the City to conduct interviews with owners, principals, officers, employees and applicable subcontractors/suppliers participating on the contract to substantiate the actual work performed by the Small Business firms on this contract. A Prime Bidder/Offeror who intentionally and/or knowingly misrepresents material facts shall be debarred for a period of time of not less than one year. |
Authorized Signature Printed Signature
Title Contact Name and Title (if different)
Company Name Phone Number
Address Email Address
City/State/Zip Code Date
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