3-RFP-04-Small Business Utilization Form V1.docx
DOCX document 52 KB Posted
- Attached to
- HVAC Filters
- Solicitation number
- 26-0262
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form required by the City of Fort Worth for the HVAC Filters procurement. The City of Fort Worth has established a Small Business Goal of 30% for this procurement, which may be achieved through self-performance by a prime contractor certified as a Small Business, utilization of one or more certified Small Business subcontractors, or a combination of both. All bidders are required to complete this form in its entirety and submit current valid certifications for all Small Businesses claimed toward the goal. A Small Business is defined as a business entity located in Tarrant, Wise, Johnson, Parker, or Denton County that holds current certification from an organization approved by the City Manager. Failure to complete the form or submit current certifications may result in zero points awarded for the Small Business Goal criteria and evaluation based solely on remaining best value criteria.
Bidders must list all subcontractors and suppliers utilized to meet the Small Business Goal, including their legal names as shown on certification, addresses, contact information, types of services, NAICS codes, dollar amounts, and certifying agencies. The form requires breakdown of total dollar amounts for bidder services toward the goal, Small Business subcontractors, and non-Small Business subcontractors. Bidders must agree to provide complete and accurate information regarding actual work performed by subcontractors, permit audits and examinations of books and records, and facilitate interviews with authorized City representatives to substantiate work performed. Bidders who intentionally or knowingly misrepresent material facts may be deemed non-responsible and disqualified from future City bids.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 6-RFP-06-Draft Vendor Service Agreement.pdf | ||
| 4-RFP-03-Authorized Signature and Questionnaire.pdf | ||
| 9-Addendum No. 2.pdf | ||
| 1-RFP-05-Forms.pdf | ||
| 2-RFP-01-Instruction to Proposers.pdf | ||
| 7-Addendum No. 1.pdf | ||
| 8-RFP-02-Scope of Services V2.pdf | ||
| 5-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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