13-Section 00 45 42.pdf
PDF 189 KB Posted
- Attached to
- ITB - Athletic Field Improvements at Rockwood, Rolling Hills, Northwest Community and Gateway Parks
- Solicitation number
- 26-0273
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form required by the City of Fort Worth for bidders and offerors on a competitive solicitation for Athletic Field Improvements at Rockwood, Rolling Hills, Northwest Community, and Gateway Parks. The project encompasses installation of remote equipment controllers at Gateway Park, rehabilitation of softball infields at Gateway and Rockwood Parks, construction of bleacher shading structures at Northwest Community Park, and lighting installation and grassing replacement at Rockwood Park. The form requires prime bidders and all subcontractors to be identified regardless of small business status, with complete certification documentation from approved agencies before bid submission. The marketplace for small business participation is defined as Denton, Parker, Wise, Tarrant, and Johnson counties, and all small business firms must be physically located within the City's marketplace at the time of bid.
The form establishes a small business contract goal for the project and requires bidders to provide detailed cost breakdowns for prime contractor services, certified small business subcontractors and suppliers, and non-small business subcontractors and suppliers, with all percentages totaling 100 percent of the contract value. Certified small business firms must be certified through one of the following agencies: North Central Texas Regional Certification Agency (NCTRCA), Women's Business Council - Southwest (WBCS), Dallas/Fort Worth Business Council (DFW BC), Texas HUB Program, Texas Unified Certification Program (TUP), or TXDOT's SBE Directory. Prime bidders are required to provide documentation of actual work performed by subcontractors and agree to allow city audits and interviews with relevant parties. Any unjustified changes or deletions to the small business utilization schedule constitute material breach of contract and may result in debarment, with intentional misrepresentation of material facts resulting in debarment for a period of not less than one year.
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Text version
PRIME BIDDER/OFFEROR
COMPANY NAME
PROJECT NAME:
PROJECT NUMBER:
BID DATE:
Prime Bidder/Offeror is a Small Business:
00 45 42
City’s Small Business Goal
#DIV/0!
Bidder/Offeror’s Commitment
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%.
No
Small Business Utilization Form
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.
Total Contract $ Amount
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Type of Services or Supplies
NAMES AND ADDRESSES OF *PRIME CONTRACTOR* TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
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.
NAICS Code:
Small Business
$ AMOUNT:
No
Type of Services or Supplies
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Small Business Yes
$ AMOUNT:
Phone:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
Type of Services or Supplies
Small Business No
$ AMOUNT:
Small Business No
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Type of Services or Supplies
NAICS Code:
Small Business
Type of Services or Supplies
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Type of Services or Supplies
Small Business
Type of Services or Supplies
Small Business
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
NAICS Code:
Type of Services or Supplies
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Small Business
$ AMOUNT:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
Business Name:
Type of Services or Supplies
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Type of Services or Supplies
Small Business
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) NAICS Code:
Small Business
$ AMOUNT:
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Type of Services or Supplies
Small Business
Email:
Contact Person:
Business Name:
Address (including County):
Phone:
Email:
Contact Person:
$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
NAICS Code:
Type of Services or Supplies
Small Business
Type of Services or Supplies
Small Business
0.00
0.00
0.00
Total Dollar Amount of Small Business Subcontractors/Suppliers
Total Dollar Amount of Non-Small Business Subcontractors/Suppliers
TOTAL AMOUNT BID
$ AMOUNT:
Total Dollar Amount of Prime Bidder/Offeror Services (Non- Small Business) 0.00
Total Dollar Amount of Certified Prime Bidder/Offeror Services towards Small Business contract goal 0
Title
Printed Signature
Contact Name and Title (if different)
Phone NumberCompany Name
Authorized Signature
Address Email Address
City/State/Zip Code Date
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.
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