7-00 45 42 Small Business Utilization Form (1).xlsx

XLSX spreadsheet 75 KB Posted

Attached to
PW 2027 Concrete Restoration Contract 3, City Project No. 106806
Solicitation number
26-0306
Issued by
Tarrant County, Texas

About this file

Written by GovTribe AI ·

This is a Small Business Utilization Form for the City of Fort Worth, Texas, related to a concrete restoration project (PW 2027 Concrete Restoration Contract 3, City Project No. 106806). The project involves approximately 11,705 square yards of 9-inch concrete pavement, 3,685 square yards of 7-inch concrete pavement, 2,000 cubic yards of flex base, and 8,000 square yards of geogrid installation. The form requires bidders to identify all contractors and subcontractors, regardless of small business status, and must be completed in its entirety and submitted with bid documentation to avoid rejection as non-responsive.

The City of Fort Worth has established a 30 percent small business utilization goal for this contract. All small business firms must be certified 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 HUB Program, Texas Unified Certification Program (TUP), DBE/ACDBE, or TXDOT SBE Directory. Small businesses must be physically located within the designated marketplace comprising Denton, Parker, Wise, Tarrant, and Johnson counties. Prime bidders cannot make changes to the subcontractor list without prior City approval, and any unjustified modifications constitute a material breach of contract subject to debarment. Bidders must provide complete and accurate information regarding actual work performed and permit City audits and interviews with owners, principals, and subcontractors to substantiate small business participation.

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Other files

File Type Posted
10-Sign in Sheet 2027 Concrete Restoration Contract 3.pdf PDF
11-CPN106806 Pre-Bid Conference.pdf PDF
3-00 61 14 Payment Bond.doc DOC document
8-00 61 13 Performance Bond.doc DOC document
5-00 61 19 Maintenance Bond.doc DOC document
6-00 11 13 Invitation to Bidders.docx DOCX document
2-00 45 26 Contractor Compliance.doc DOC document
13-Addendum No. 1.pdf PDF
1-00 52 43 Agreement.docx DOCX document
14-Submission Instructions - 26-0306 (rev. 091026).docx DOCX document
9-Project Manual CPN106806.pdf PDF
12-00 41 00 Bid Proposal Workbook - Addendum No. 1.xlsx XLSX spreadsheet
4-00 21 13 Instruction to Bidders (1).docx DOCX document
Show all 13

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Sheet1

00 45 42
Small Business Utilization Form
PRIME BIDDER/OFFEROR COMPANY NAME
PROJECT NAME:
PROJECT NUMBER:Total Contract $ Amount
BID DATE:City’s Small Business GoalBidder/Offeror’s Commitment
Prime Bidder/Offeror is a Small Business:No30%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 BusinessNo
Contact Person:$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERSTYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
Business Name:NAICS Code:
Address (including County):Type of Services or Supplies
Phone:
Email:Small BusinessYes
Contact Person:$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERSTYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
Business Name:NAICS Code:
Address (including County):Type of Services or Supplies
Phone:
Email:Small BusinessNo
Contact Person:$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERSTYPE OF SERVICES/SUPPLIES PROVIDED (NAICS Required)
Business Name:NAICS Code:
Address (including County):Type of Services or Supplies
Phone:
Email:Small BusinessNo
Contact Person:$ AMOUNT:
NAMES AND ADDRESSES OF SUBCONTRACTORS/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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/SUPPLIERSTYPE 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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