7-36 01 2Small Business Utilization Form.doc
DOC document 145 KB Posted
- Attached to
- PW Bridge Rail Unit Price Contract
- Solicitation number
- 26-0044
- Issued by
- Tarrant County, Frankston Town, Texas
About this file
The document is a Small Business Utilization Form for a City of Fort Worth contract opportunity, specifically the PW Bridge Rail Unit Price Contract. The project involves repairing and replacing bridge handrails, guardrails, and attenuators, with the primary purpose of establishing unit prices for potential work. The contract has a flexible budget that may be less than the bid amount and can be renewed for up to two additional terms, with a total contract duration not exceeding five years from the initial effective date. The City's marketplace for small business participation is defined as Denton, Parker, Wise, Tarrant, and Johnson counties.
The form emphasizes small business participation, with a city goal of 30% small business utilization. Certified small businesses must be verified by specific agencies including 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). Prime contractors are required to identify all subcontractors and suppliers, with only certified small businesses counting toward the contract goal. Misrepresentation of facts can result in bid disqualification or debarment, and contractors must be prepared to provide detailed documentation and allow audits of their work and subcontractor relationships.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-00 45 41 Small Business Goal (1).doc | DOC document | |
| 8-00 52 43 Agreement.docx | DOCX document | |
| 9-00 61 19 Maintenance Bond.doc | DOC document | |
| 5-00 11 13 Invitation to Bidders BONFIRE.doc | DOC document | |
| 10-00 21 13 Instruction to Bidders (1).docx | DOCX document | |
| 11-Submission Instructions - 26-0044.docx | DOCX document | |
| 2-Project Manual Bridge Rail Unit Price Contract.pdf | ||
| 6-00 61 14 Payment Bond.doc | DOC document | |
| 1-00 41 00 Bid Proposal Workbook.xlsx | XLSX spreadsheet | |
| 4-00 61 13 Performance Bond.doc | DOC document |
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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 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.
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.
| 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 |
| 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
Revised 9/18/2025
File details come from the government source that posted it. Updated .