4-Small Business Utilization Form.pdf
PDF 251 KB Posted
- Solicitation number
- 26-0028
- Issued by
- Tarrant County, Texas
About this file
The Small Business Utilization Form is a document from the City of Fort Worth designed to promote small business participation in municipal contracts, involving certification agencies including the North Central Texas Regional Certification Agency (NCTRCA), Women's Business Council – Southwest (WBCS), Dallas/Fort Worth Minority Supplier Development Council (DFW MDSC), and Texas Department of Transportation (TXDOT). The form establishes a small business goal of 30% for the project, requiring prime contractors to identify and list certified small business subcontractors and suppliers located within Denton, Parker, Wise, Tarrant, and Johnson counties.
The document outlines strict requirements for small business certification, mandating that only certified small businesses in specific NAICS commodity codes can be counted towards the contract goal. Prime bidders must provide detailed information about subcontractors, including business names, addresses, contact information, types of services/supplies, NAICS codes, and dollar amounts. The form includes provisions that prohibit unauthorized changes to the certified list, with potential consequences such as contract breach and debarment for misrepresentation. Prime contractors agree to provide documentation and allow audits to verify the actual work performed by small business firms, emphasizing transparency and accountability in the contract procurement process.
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Text version
Small Business Utilization Form Page 1 of 5
Revised 9/18/2025
PRIME
BIDDER/OFFEROR
COMPANY NAME:
PROJECT NAME:
PROJECT NUMBER: City’s Small Business Goal Bidder/Offeror’s Commitment
BID DATE: 30 % ___ %
Check all applicable boxes to describe Prime Contractor Bidder/Offeror Owner's Classification:
☐ Not Certified
☐ Small Business
Certifying Agency: ☐ NCTRA ☐ WBCS ☐ DFW MDSC ☐ TXDOT
ALL SMALL BUSINESS FIRMS MUST BE CERTIFIED BEFORE BID
Failure to complete this form in its entirety and submit it with the Bid/Offer will result in the bid being considered non-responsive to bid specifications.
The undersigned Prime Bidder/Offeror agrees to enter into a formal agreement with the Small Business firm(s) listed in this utilization schedule, conditioned the City of Fort Worth upon execution of a contract, with the intentional and/or knowing misrepresentation of facts is grounds for consideration of disqualification and will result in the bid being considered non-responsive to bid specifications.
Small Business firms listed toward meeting the project goal must be 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, located in the marketplace, that have been determined to be bona fide 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 Minority Supplier Development Council (DFW MDSC), and Texas Department of Transportation (TXDOT).
Please note that only certified Small Business firms will be counted to meet the Small Business goal. Prime Bidders/Offerors are required to identify ALL subcontractors/suppliers, regardless of status.
Small Business Utilization Form Page 2 of 5
Certified Small Business Prime/Bidder/Offeror Contractors, counting their self-performance towards meeting the contract goal, must be certified within those NAICS commodity codes with a certifying agency acceptable by the City of Fort Worth. Certified Small Business Prime/Bidder/Offeror, counting self-performing services towards the goal, the service(s) to be performed should be listed first on the Utilization form.
Check this box if certified Prime Contractor services will be counted towards the Small Business contracting goal. ☐
Please list certified Small Business firm names as listed on their certification including DBA names.
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS
Required)
Specify Tier Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW MDSC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS
Required)
Specify Tier Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW MDSC
Contact Person: $ AMOUNT: ☐ TXDOT
Please include multiple copies of this page if needed to list all contractors and suppliers.
Small Business Utilization Form Page 3 of 5
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS
Required)
Specify Tier Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW MDSC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS
Required)
Specify Tier Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW MDSC
Contact Person: $ AMOUNT: ☐ TXDOT
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS
Required)
Specify Tier Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW MDSC
Contact Person: $ AMOUNT: ☐ TXDOT
Small Business Utilization Form Page 4 of 5
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 DOLLAR AMOUNT OF PRIME/ALL SUBCONTRACTORS/SUPPLIERS $
The Prime Bidder/Offeror will not make additions, deletions, or substitutions to this certified 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.
By affixing a signature to this form, the Prime Bidder/Offeror further 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 the transmission of interviews with owners, principals, officers, employees and applicable subcontractors/suppliers participating on the contract that will substantiate the actual work performed by the Small Business firms on this contract, by an authorized officer or employee of the City. A Prime Bidder/Offerer 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
Small Business Utilization Form Page 5 of 5
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