2-RFP-06-Small Business Utilization Form V1.docx
DOCX document 52 KB Posted
- Attached to
- RFP Online Backflow Testing Management Solution
- Solicitation number
- 26-0221
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form for a procurement by the City of Fort Worth, Texas, related to an Online Backflow Testing Management Solution for the Water Department. The form establishes bidder requirements and compliance documentation for participation in the procurement process. Bidders must complete all sections of the form and submit current certifications for any small business entities they intend to utilize. The form requires bidders to identify whether they are certified Small Business Enterprises (SBEs), list all subcontractors and suppliers being used to meet small business goals, provide contact information and service descriptions for each small business participant, and disclose the dollar amounts associated with each firm's involvement in the project.
The City of Fort Worth has established a 30 percent small business goal for this procurement, which can be achieved through prime contractor self-performance as a certified small business, utilization of certified small business subcontractors, or a combination of both approaches. Eligible small businesses must be located in Tarrant, Wise, Johnson, Parker, or Denton County and hold current certification from a City Manager-approved organization. Bidders must provide current valid certifications for all small businesses listed with their submission; failure to do so may result in zero points awarded for the small business criteria and evaluation based solely on remaining best value factors. Bidders are required to execute formal agreements with any small business subcontractors or suppliers listed on the form if awarded the contract and must allow the City to audit records, examine books and files, and conduct interviews to verify actual work performed by small business participants.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-RFP-02-Scope of Services.pdf | ||
| 7-RFP-04-Authorized Signature and Questionnaire.docx | DOCX document | |
| 1-RFP-05-Forms.pdf | ||
| 3-RFP-01-Instruction to Proposers.docx | DOCX document | |
| 5-RFP-03-Draft VSA.pdf | ||
| 4-RFP-07-Deviations.xlsx | XLSX spreadsheet |
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Text version
The City of Fort Worth has set a Small Business Goal of 30% for this procurement. That goal may be met by self-performance by a prime contractor that is a certified Small Business, utilization of one or more subcontractors that are certified Small Businesses, or a combination of both.
BIDDER LEGAL NAME:
Bid Name: Bid Number:
Certifying Agency:
| City’s Small Business Goal is 30% if Bidder would like to commit to a higher percentage, please provide % |
| Are you a certified Small Business Enterprise (SBE)? |
Yes No
ALL BIDDERS MUST COMPLETE THIS FORM.
ALL SMALL BUSINESS FIRMS MUST BE CERTIFIED PRIOR TO SUBMITTING A BID SUBMISSION.
A Small Business means a business entity that is located in Tarrant, Wise, Johnson, Parker or Denton County and that holds current certification as a small business from an organization approved by the City Manager for each commodity and service code listed. A copy of the current certification for each Small Business (including Bidder, if a Small Business seeking credit for self-performance) must be submitted with the bid.
Failure to (i) complete this form in its entirety or (ii) submit a current valid certification for all Small Businesses to be used with this Bid/Offer may result in zero points being awarded with respect to the Small Business Goal criteria during bid evaluation and with the bid being awarded points based solely on the remaining best value criteria.
If the undersigned Bidder is awarded a contract for this procurement, the Bidder must execute a formal agreement with each Small Business that Bidder uses as a subcontractor or supplier that is listed on this form.
Please list all subcontractors and suppliers being utilized to meet the Small Business Goal for this procurement.
Please list certified Small Business firm names as listed on their certification, including DBA names.
| Contractors/Suppliers Legal Name |
| Address |
| Contact information: Name/Phone/Email |
| Types of Services |
| NAICS Code(s) |
| $ Amount |
| Certifying Agency |
| Contractors/Suppliers Legal Name |
| Address |
| Contact information: Name/Phone/Email |
| Types of Services |
| NAICS Code(s) |
| $ Amount |
| Certifying Agency |
| Contractors/Suppliers Legal Name |
| Address |
| Contact information: Name/Phone/Email |
| Types of Services |
| NAICS Code(s) |
| $ Amount |
| Certifying Agency |
City of Fort Worth Small Business Utilization Form
10.1.2025-V1
| Total Dollar Amount of Bidder Services towards small business goal |
| $ |
| Total Dollar Amount of Small Business Subcontractors |
| $ |
| Total Dollar Amount of Non-Small Business Subcontractors |
| $ |
| TOTAL DOLLAR AMOUNT |
| $ |
By affixing a signature to this form, Bidder further agrees to provide, directly to the City upon request, complete and accurate information regarding actual work performed by all subcontractors. The Bidder also agrees to allow an audit and/or examination of any books, records, and files held by their company related to the job being bid and/or the subcontractors being utilized. The Bidder agrees to allow and facilitate interviews by an authorized officer or employee of the City with owners, principals, officers, employees, and applicable subcontractors/suppliers participating on the contract in order to substantiate the actual work performed by the Small Business(es) under this contract.
A Bidder who intentionally and/or knowingly misrepresents material facts may no longer be considered a responsible bidder and therefore disqualified from consideration with respect to future City bids.
Legal Company Name: ___________________________________________________
Authorized Signature: ____________________________________________________
Printed Name: __________________________________________________________
Title: __________________________________________________________________
Address (Street, City, State, Zip): ____________________________________________
Phone Number: __________________________________________________________
Email address: ___________________________________________________________ image1.png image2.png
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