6-Small Business Utilization Form.pdf
PDF 114 KB Posted
- Attached to
- PW-Cibolo Hills Parkway
- Solicitation number
- 26-0148
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form for the City of Fort Worth's Cibolo Hills Parkway project (Project Number 106104). The form establishes the City's small business participation goal of 30 percent and requires prime bidders and offerors to identify all subcontractors and suppliers, with certified small business firms counting toward meeting the stated goal. Certified small businesses must be located in Denton, Parker, Wise, Tarrant, and Johnson counties and hold current certifications from one of six recognized 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 Program (HUB), Texas Unified Certification Program (TUCP), or Texas Department of Transportation SBE Directory (TXDOT). The project involves approximately 1,569 linear feet of 16-inch PVC waterline, 348 linear feet of 16-inch DIP waterline, 1,069 to 1,010 linear feet of reinforced concrete pipe and storm box culverts, 6,369 square yards of 10-inch concrete pavement, 24,287 square feet of concrete sidewalk, and 22 roadway lighting assemblies with LED fixtures and associated infrastructure improvements.
Prime bidders must provide complete information on all contractors and suppliers, including certified small business firms, non-small business subcontractors, their services or supplies (identified by NAICS codes), certification agencies, addresses, contact information, and contract dollar amounts. The form requires bidders to certify that they will not make additions, deletions, or substitutions to the listed subcontractors without prior City approval, and failure to do so may constitute a material breach of contract. Bidders must agree to provide documentation of actual work performed by all subcontractors, permit audits and examinations of company records and files, and allow interviews with owners, principals, and employees to substantiate small business participation on the contract. The form also stipulates that prime bidders who intentionally or knowingly misrepresent material facts may be deemed not responsible on future bid opportunities.
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Text version
Small Business Utilization Form Page 1 of 5
Revised 9/18/2025(dwbRL10.15.25)
PRIME
BIDDER/OFFEROR
COMPANY NAME:
PROJECT NAME: Cibolo Hills Parkway
PROJECT NUMBER: 106104 City’s Small Business Goal Bidder/Offeror’s Commitment
BID DATE: 30 % ___ %
Check all applicable boxes to describe Prime Bidder/Offeror Owner's Classification:
☐ Not Certified
☐ Small Business
Certifying Agency: ☐ NCTRA ☐ WBCS ☐ DFW BC ☐ HUB
☐ TXDOT
☐ TUCP
ALL SMALL BUSINESS FIRMS MUST BE CERTIFIED BEFORE BID
Failure to complete this form in its entirety and submit it with the Bid/Offer may result in the bid being considered non-responsive to bid specifications.
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 l oc a t ed in Denton, Parker, Wise, Tarrant, and Johnson counties.
Certified means those Small Business Firms 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 Business Council (DFW BC), Texas Historically Underutilized Business Program (HUB), Texas Unified Certification Program DBE/ACDBE (TUCP), and Texas Department of Transportation SBE Directory (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
9/18/2025(dwbRL10.15.25)
Certified Small Business Prime/Bidder/Offeror Contractors, counting their self-performance towards meeting the contract goal, must be certified within those NAICS commodity codes for the work it intends to perform. Certified Small Business Prime/Bidder/Offeror counting self-performing services towards the goal 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 (List Prime Contractor first if Prime Contractor will be counted toward meeting the SB Goal
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAICS Required)
Specify Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address (including County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
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 (including County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
Small Business Utilization Form Page 3 of 5
9/18/2025(dwbRL10.15.25)
Please include multiple copies of this page if needed to list all contractors and suppliers.
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 (including County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
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 (including County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
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:
Small Business Utilization Form Page 4 of 5
9/18/2025(dwbRL10.15.25)
Address (including County):
☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☐ DFW BC
Contact Person: $ AMOUNT: ☐ TXDOT
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 may be a material breach of contract.
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 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/Offeror who intentionally and/or knowingly misrepresents material facts may be considered not to be a responsible bidder on future bid opportunities.
Authorized Signature Printed Signature
Title Contact Name and Title (if different)
Small Business Utilization Form Page 5 of 5
9/18/2025(dwbRL10.15.25)
Company Name Phone Number
Address Email Address
City/State/Zip Code Date
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