7-Small Business Utilization Form.pdf
PDF 147 KB Posted
- Solicitation number
- 26-0029
- Issued by
- Tarrant County, Frankston Town, Texas
About this file
The document is a Small Business Utilization Form issued by the City of Fort Worth, involving certification agencies including North Central Texas Regional Certification Agency (NCTRCA), Women's Business Council – Southwest (WBCS), Dallas/Fort Worth Minority Supplier Development Council (MSDC), and Texas Department of Transportation (TXDOT). The form is designed to track and encourage small business participation in city contracts, with a citywide small business goal of 30%. Bidders are required to list all subcontractors and suppliers, specifying their certification status, type of services, NAICS codes, and dollar amounts.
The form requires prime contractors to identify their business classification (in this case, not certified) and commit to a specific percentage of small business utilization. Small businesses must be certified by one of the specified agencies and located in the designated marketplace (Denton, Parker, Wise, Tarrant, and Johnson counties). The document emphasizes that only certified small business firms will be counted towards meeting the contract goal, and prime bidders must provide detailed information about subcontractors. Failure to complete the form accurately or misrepresenting information can result in the bid being considered non-responsive or the bidder being debarred for at least one year.
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Text version
Small Business Utilization Form Page 1 of 5
Revised 9/01/2025
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 ☐ MSDC ☐ 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 (MSDC), and Texas Department of Transportation (TXDOT).
Small Business Utilization Form Page 2 of 5
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: ☐ MSDC
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: ☐ MSDC
Contact Person: $ AMOUNT: ☐ TXDOT
Small Business Utilization Form Page 3 of 5
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
(NAISC Required)
Specify Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☒ TXDOT
Contact Person: $ AMOUNT: ☐
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: ☒ TXDOT
Contact Person: $ AMOUNT: ☐
NAMES AND ADDRESSES OF
CONTRACTORS/SUPPLIERS
TYPE OF SERVICES/SUPPLIES PROVIDED
(NAISC Required)
Specify Tier
Certification Agency
Business Name: Type of Services/Supplies: Certified by:
Address: ☐ NCTRCA
Phone: ☐ WBCS
Email: NAICS Code: ☒ TXDOT
Contact Person: $ AMOUNT: ☐
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 (1) years.
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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