2-00 45 42 Small Business Utilization Form.xlsx
XLSX spreadsheet 74 KB Posted
- Solicitation number
- 26-0332
- Issued by
- Tarrant County, Fort Worth City, Texas
About this file
This is a Small Business Utilization Form for the City of Fort Worth, Texas, applicable to the Marine Creek Sanitary Sewer Parallel Interceptor M-279 & M-245B - Part II project. The form requires bidders to identify all prime contractors, subcontractors, and suppliers participating in the project, along with their NAICS codes, service descriptions, physical locations, and contract amounts. The City of Fort Worth has established a 30 percent small business goal for this contract. All small business firms must be certified by an approved certifying agency including the 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, Texas Unified Certification Program (TUP), or Texas Department of Transportation (TXDOT) before bid documentation submission. Small business firms must be physically located within the City's marketplace, defined as Denton, Parker, Wise, Tarrant, and Johnson counties.
The form requires bidders to list the prime contractor first with their dollar participation, followed by certified small business firms, and finally non-small business firms. Small business supplier percentages must be deducted from the prime or subcontractor percentages installing supplied products, with all percentages totaling 100 percent. Bidders must provide complete and accurate information regarding actual work performed by all subcontractors and must allow City audits and interviews with participating firms. The form explicitly warns that intentional misrepresentation of material facts shall result in debarment for a period of not less than one year, and any unjustified changes or deletions to the subcontractor list constitute material breach of contract potentially resulting in debarment. Failure to complete the form in its entirety and submit it with the bid may render the bid non-responsive.
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Text version
Sheet1
| 00 45 42 | |||||
| Small Business Utilization Form | |||||
| PRIME BIDDER/OFFEROR COMPANY NAME | |||||
| PROJECT NAME: | |||||
| PROJECT NUMBER: | Total Contract $ Amount | ||||
| BID DATE: | 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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