5-00 45 42 Small Business Utilization Form.xlsx
XLSX spreadsheet 74 KB Posted
- Solicitation number
- 26-0329
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form for the City of Fort Worth, Texas, related to a Concrete Pavement Repair Unit Price Contract for various projects. The form documents the bidder's commitment to utilizing certified small businesses in performance of the contract work. The contract encompasses miscellaneous task orders for pavement rehabilitation, including concrete pavement repair or replacement, repair of concrete curb and gutter, concrete sidewalks, curb ramps, and driveways. The City is establishing unit prices through this solicitation and is not obligated to award the full bid amount if the contract budget is less than the amounts proposed.
The City of Fort Worth has established a 30 percent small business utilization goal for this project. All small business firms must be certified before bid submission by an approved certifying agency, including the 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, Texas Unified Certification Program (TUP), DBE/ACDBE, or Texas Department of Transportation (TXDOT) SBE Directory. Small businesses must be physically located within the designated marketplace comprising Denton, Parker, Wise, Tarrant, and Johnson counties. Prime bidders are required to identify all subcontractors and small business suppliers, with total participation percentages equaling 100 percent. The prime bidder/offeror is responsible for providing accurate information regarding actual work performed and must consent to audits and interviews conducted by the City to verify small business participation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4-Concrete Pavement Repair UPC.xlsx | XLSX spreadsheet | |
| 1-00 11 13 Invitation to Bidders.docx | DOCX document | |
| 2-00 45 26 Contractor Compliance with Workers Compensation Law.doc | DOC document | |
| 6-Concrete Pavement Repair UPC Project Manual.pdf | ||
| 3-Bid Documents Package Folder Contents Checklist.doc | DOC document | |
| 7-Submission Instructions - 26-0329.docx | DOCX document |
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Text version
Sheet1
| 00 45 42 | |||||
| Small Business Utilization Form | |||||
| PRIME BIDDER/OFFEROR COMPANY NAME | |||||
| PROJECT NAME: | Concrete Pavement Repair Unit Price Contract | ||||
| PROJECT NUMBER: | Various Projects | Total Contract $ Amount | |||
| BID DATE: | City’s Small Business Goal | Bidder/Offeror’s Commitment | |||
| Prime Bidder/Offeror is a Small Business: | No | 30 | % | ERROR:#DIV/0! | % |
| 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, regardless of status. Small Business Suppliers shall be identified. The Small Business supplier % should be removed from the prime/subcontractor's % that is instaling the supplied product. |
The total % of all Prime/Subcontractors and Small Business suppliers should equal 100%.
| 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. | ||
| 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 *PRIME CONTRACTOR* | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | Yes |
| Contact Person: | $ AMOUNT: | |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: | |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) | |
| Business Name: | NAICS Code: | |
| Address (including County): | Type of Services or Supplies | |
| Phone: | ||
| Email: | Small Business | No |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERS | TYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required) |
| Business Name: | NAICS Code: |
| Address (including County): | Type of Services or Supplies |
| Phone: | |
| Email: | Small Business |
| Contact Person: | $ AMOUNT: |
| Total Dollar Amount of Certified Prime Bidder/Offeror Services towards Small Business contract goal | $ | 0 |
| Total Dollar Amount of Prime Bidder/Offeror Services (Non- Small Business) | $ | 0.00 |
| Total Dollar Amount of Small Business Subcontractors/Suppliers | $ | 0.00 |
| Total Dollar Amount of Non-Small Business Subcontractors/Suppliers | $ | 0.00 |
| TOTAL AMOUNT BID | $ | 0.00 |
| 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
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