11-Small Business Utilization Form.pdf
PDF 73 KB Posted
- Attached to
- PW-Alpha Ranch Parkway & Comancheria Way Offsite Water Line (City Project Number 106400)
- Solicitation number
- 26-0093
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form issued by the City of Fort Worth, Texas, for the Alpha Ranch Parkway & Comancheria Way Offsite Water Line project (City Project Number 106400). The form requires prime bidders and offerors to document their commitment to meeting the city's 30 percent small business goal and to identify all subcontractors and suppliers participating in the project. The major work consists of approximately 8,531 linear feet of 16-inch water line installation by open cut and 4,456 linear feet of 30-inch water line installation by open cut. All small business firms must be certified by one of the designated certifying agencies—including the North Central Texas Regional Certification Agency, Women's Business Council - Southwest, Dallas/Fort Worth Business Council, Texas HUB Program, Texas Unified Certification Program, or Texas Department of Transportation—and must be located in Denton, Parker, Wise, Tarrant, or Johnson counties to count toward the project goal.
Prime bidders and offerors are required to complete the form in its entirety and submit it with their bid or offer, with failure to do so potentially rendering the bid non-responsive. The form requires documentation of all certified small business subcontractors and suppliers, including their business names, types of services or supplies, NAICS codes, certification agencies, addresses, contact information, and contract amounts. Prime bidders must also provide total dollar amounts for certified prime bidder services, small business subcontractors and suppliers, non-small business subcontractors and suppliers, and the aggregate total of all participants. Upon contract award, the prime bidder agrees not to make additions, deletions, or substitutions to the certified subcontractor and supplier list without prior city approval, and agrees to provide complete and accurate information regarding actual work performed, permit audits and examinations of company records, and allow interviews with owners, principals, officers, and employees to substantiate small business participation on the contract.
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Text version
Small Business Utilization Form Page 1 of 5
Revised
9/18/2025(dwbRL10.15.25)
PRIME
BIDDER/OFFEROR
COMPANY NAME:
PROJECT NAME:
PROJECT NUMBER: City’s Small Business Goal Bidder/O'eror’s Commitment
BID DATE: 30 % ___ %
Check all applicable boxes to describe
Prime Bidder/O'eror
Owner's
Classification:
☐ Not
Certified ☐ Small
Business
Certifying Agency: ☐ NCTRA ☐ WBCS ☐ DFW BC ☐ HUB
☐ TXDOT
☐ TUCP
ALL SMALL BUSINESS FIRMS MUST BE CERTIFIED BEFORE BID
Failure to complete this form in its entirety and submit it with the Bid/Offer may result in the bid being considered non-responsive to bid specifications.
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 l oc a t ed in Denton, Parker, Wise, Tarrant, and Johnson counties.
Certified means those Small Business Firms that have been determined to be bona fide 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 Program (HUB), Texas Unified Certification Program DBE/ACDBE (TUCP), and Texas Department of Transportation SBE Directory (TXDOT).
Please note that only certified Small Business firms will be counted to meet the Small Business goal. Prime Bidders/O>erors are required to identify
ALL subcontractors/suppliers, regardless of status.
Small Business Utilization Form Page 2 of 5
9/18/2025(dwbRL10.15.25)
Certified Small Business Prime/Bidder/O>eror Contractors, counting their self-performance towards meeting the contract goal, must be certified within those NAICS commodity codes for the work it intends to perform. Certified Small Business Prime/Bidder/O>eror counting self-performing services towards the goal should be listed first on the Utilization form.
Check this box if certified Prime Contractor services will be counted towards the Small Business contracting goal. ☐
Please list certified Small Business firm names as listed on their certification including DBA names.
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS (List Prime
Contractor first if Prime Contractor will be counted toward meeting the SB Goal
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify
Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address
(including
County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify
Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address
(including
County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
Small Business Utilization Form Page 3 of 5
9/18/2025(dwbRL10.15.25)
Please include multiple copies of this page if needed to list all contractors and suppliers.
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify
Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address
(including
County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify
Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address
(including
County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify
Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Small Business Utilization Form Page 4 of 5
9/18/2025(dwbRL10.15.25)
Address
(including
County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
Total Dollar Amount of Certified Prime Bidder/O'eror Services towards contract goal $
Total Dollar Amount of Small Business Subcontractors/Suppliers $
Total Dollar Amount of Non-Small Business Subcontractors/Suppliers $
TOTAL DOLLAR AMOUNT OF PRIME/ALL SUBCONTRACTORS/SUPPLIERS $
The Prime Bidder/O'eror will not make additions, deletions, or substitutions to this certified list without the prior approval of the City of Fort Worth. Any unjustified change or deletion may be a material breach of contract.
By a'ixing a signature to this form, the Prime Bidder/O'eror further agrees to provide, directly to the City upon request, complete and accurate information regarding actual work performed by all subcontractors. The Prime Bidder/O'eror also agrees to allow an audit and/or examination of any books, records and files held by their company. The Prime Bidder/O'eror agrees to allow interviews with owners, principals, o'icers, employees and applicable subcontractors/suppliers participating on the contract that will substantiate the actual work performed by the Small Business firms on this contract, by an authorized o'icer or employee of the City. A Prime
Bidder/O'eror who intentionally and/or knowingly misrepresents material facts may be considered not to be a responsible bidder on future bid opportunities.
Authorized Signature Printed Signature
Title Contact Name and Title (if di'erent)
Small Business Utilization Form Page 5 of 5
9/18/2025(dwbRL10.15.25)
Company Name Phone Number
Address Email Address
City/State/Zip Code Date
File details come from the government source that posted it. Updated .