2-RFP-06-Small Business Utilization Form V1.docx
DOCX document 52 KB Posted
- Attached to
- RFP Meter Boxes and Lids
- Solicitation number
- 26-0096
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form required by the City of Fort Worth for the RFP Meter Boxes and Lids procurement for the Water Department. The City has established a small business goal of 30% for this contract opportunity, which may be satisfied through self-performance by a prime contractor certified as a small business, utilization of certified small business subcontractors, or a combination of both approaches. Bidders must complete the form in its entirety and submit current certifications for all small businesses used in the bid submission. Small businesses are defined as entities located in Tarrant, Wise, Johnson, Parker, or Denton County that hold current certification from an organization approved by the City Manager for the relevant commodity and service codes.
Failure to complete the form or submit valid certifications for all small businesses may result in zero points being awarded for the small business goal criteria during bid evaluation. Bidders must identify all subcontractors and suppliers by certified legal name, provide their addresses and contact information, specify types of services and NAICS codes, and list dollar amounts and certifying agencies. The form requires bidders to segregate the total dollar amount into categories for bidder services toward the small business goal, small business subcontractors, and non-small business subcontractors. Bidders who are awarded the contract must execute formal agreements with each small business subcontractor or supplier listed on the form and agree to provide complete information regarding work performed, allow audits of relevant records, and facilitate interviews with authorized City representatives to substantiate actual work performed by the small business entities.
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Other files
| File | Type | Posted |
|---|---|---|
| 4-RFP-07-Deviations.xlsx | XLSX spreadsheet | |
| 3-RFP-08-Reference Sheet.pdf | ||
| 9-RFP-02-Scope of Services.pdf | ||
| 7-RFP-04-Authorized Signature and Questionnaire.pdf | ||
| 5-RFP-03-Draft Vendor Service Agreement.pdf | ||
| 6-RFP-01-Instruction to Proposers.pdf | ||
| 8-RFP-09-Discount Calculator.xlsx | XLSX spreadsheet | |
| 1-RFP-05-Forms.pdf |
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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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