4-Small Business Utilization Form.docx
DOCX document 82 KB Posted
- Solicitation number
- 26-0256
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form required by the City of Fort Worth for bidders on public works contracts, specifically applicable to the Water and Sanitary Sewer Replacement Contract 2021 (CPN 103498) in Texas. The form mandates that all bidders identify their prime contractor status, all subcontractors regardless of certification status, and suppliers as part of their bid submission. The project encompasses two units: Unit 1 involves water infrastructure improvements including 67 linear feet of 6-inch PVC water pipe, 1,248 linear feet of 8-inch PVC water pipe, 117 linear feet of 12-inch PVC water pipe, 3,727 linear feet of 16-inch PVC water pipe, 1,288 linear feet of 16-inch PVC pipe with restrained joints, 277 linear feet of 36-inch casing, two connections to existing 16-inch water mains, 23 connections to existing 4-inch to 12-inch water mains, 60 linear feet of 4-foot-wide asphalt paving repair, 1,321 linear feet of 4-foot-wide composite pavement repair, 3,100 linear feet of 5-foot-wide composite pavement repair, 41,079 square yards of 3-inch surface milling, and 41,079 square yards of 3-inch asphalt pavement. Unit 2 includes sanitary sewer improvements comprising 87 linear feet of 8-inch PVC sewer pipe, 1,497 linear feet of 12-inch PVC sewer pipe, 19 four-inch sewer services with two-way cleanouts, 9 four-foot manholes, and 730 linear feet of 4-foot-wide composite pavement repair.
The City of Fort Worth has established a small business utilization goal of 30 percent for this contract. All small business firms must be certified by approved agencies including the North Central Texas Regional Certification Agency, Women's Business Council-Southwest, Dallas/Fort Worth Business Council, Texas HUB Program, Texas Unified Certification Program, or TxDOT before bid documentation is submitted. Certified small business firms must be physically located within the designated marketplace comprising Denton, Parker, Wise, Tarrant, and Johnson counties and must be certified within the appropriate NAICS codes for their work. Prime bidders must list all subcontractors and suppliers with dollar amounts, categorizing them as certified small businesses or non-small businesses, and may not make changes to this list without prior City approval. Failure to complete the form entirely or submit it with the bid renders the bid non-responsive. Prime bidders agree to provide complete and accurate information upon request, permit audits and examinations of company records, and allow City interviews with subcontractors to substantiate work performed. Intentional misrepresentation of material facts results in debarment for a minimum of one year.
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Text version
Small Business Utilization Form
PRIME BIDDER/OFFEROR
COMPANY NAME:
PROJECT NAME:
PROJECT NUMBER:
| City’s Small Business Goal |
| Bidder/Offeror’s Commitment |
BID DATE:
| 30 % |
| ___ % |
| Check applicable box to describe Prime Bidder/Offeror | |
| ☐ | Not Small Business |
| ☐ | Small Business |
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/suppliers, regardless of status.
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.
Check this box if certified Prime Contractor services will be counted towards the Small Business contracting goal. ☐ 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 CONTRACTORS/SUPPLIERS |
| TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
Business Name:
Small Business ☐ Not Small Business ☐
Address (including County):
Type of Services/Supplies:
Phone:
Email:
NAICS Code:
Contact Person:
$ AMOUNT:
| NAMES AND ADDRESSES OF CONTRACTORS/SUPPLIERS |
| TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
Business Name:
Small Business ☐ Not Small Business ☐
Address (including County):
Type of Services/Supplies:
Phone:
Email:
NAICS Code:
Contact Person:
$ AMOUNT:
| NAMES AND ADDRESSES OF CONTRACTORS/SUPPLIERS |
| TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
Business Name:
Small Business ☐ Not Small Business ☐
Address (including County):
Type of Services/Supplies:
Phone:
Email:
NAICS Code:
Contact Person:
$ AMOUNT:
| NAMES AND ADDRESSES OF CONTRACTORS/SUPPLIERS |
| TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
Business Name:
Small Business ☐ Not Small Business ☐
Address (including County):
Type of Services/Supplies:
Phone:
Email:
NAICS Code:
Contact Person:
$ AMOUNT:
| NAMES AND ADDRESSES OF CONTRACTORS/SUPPLIERS |
| TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
Business Name:
Small Business ☐ Not Small Business ☐
Address (including County):
Type of Services/Supplies:
Phone:
Email:
NAICS Code:
Contact Person:
$ AMOUNT:
Please include additional copies of this page if needed to list all subcontractors and suppliers.
| Total Dollar Amount of Certified Prime Bidder/Offeror Services towards contract goal |
| $ |
| Total Dollar Amount of Small Business Subcontractors/Suppliers |
| $ |
| Total Dollar Amount of Non-Small Business Subcontractors/Suppliers |
| $ |
| TOTAL AMOUNT BID |
| $ |
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
| Page 1 of 2 | |
| Revised 11.06.25 | Page 2 of 5 |
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