7-Small Business Utilization Form.pdf
PDF 73 KB Posted
- Attached to
- PW-Sewer Improvements to serve Alpha Ranch Master Infrastructure Sewer, City Project No. 105879
- Solicitation number
- 26-0057
- Issued by
- Tarrant County, Texas
About this file
This is a Small Business Utilization Form issued by the City of Fort Worth for a sewer infrastructure project (Project No. 105879) serving Alpha Ranch Master Infrastructure. The project encompasses approximately 24,191 linear feet of sewer pipe installation across multiple diameter sizes, ranging from 30-inch to 12-inch pipes. The form requires prime bidders and offerors to identify all subcontractors and suppliers, with mandatory certification of small business firms before bid submission. All small business firms used to meet the city's 30 percent small business goal must be certified by recognized agencies including NCTRCA, WBCS, DFW BC, HUB, TXDOT, or TUCP, and must be located within Denton, Parker, Wise, Tarrant, and Johnson counties. Certified small business prime contractors counting self-performance toward the goal must be certified within the applicable NAICS commodity codes for their intended work.
The form establishes a structured framework for tracking small business participation, requiring prime bidders to document the business name, type of services, certification agency, address including county, phone, email, NAICS code, contact person, and dollar amounts for each subcontractor and supplier. Bidders must provide total dollar amounts for certified prime bidder services, small business subcontractors and suppliers, non-small business subcontractors and suppliers, and an aggregate total of all parties. Prime bidders are prohibited from making additions, deletions, or substitutions to the certified list without prior City approval, with unjustified changes constituting potential material breach of contract. The form requires authorized signature and includes provisions allowing the City to audit records, examine books and files, and conduct interviews with owners, principals, officers, and employees to substantiate actual work performed by small business firms on the contract.
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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:
PROJECT NUMBER: City’s Small Business Goal Bidder/O'eror’s Commitment
BID DATE: 30 % ___ %
Check all applicable boxes to describe
Prime Bidder/O'eror
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/O>erors 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/O>eror 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/O>eror 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/O'eror 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/O'eror 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 a'ixing a signature to this form, the Prime Bidder/O'eror further agrees to provide, directly to the City upon request, complete and accurate information regarding actual work performed by all subcontractors. The Prime Bidder/O'eror also agrees to allow an audit and/or examination of any books, records and files held by their company. The Prime Bidder/O'eror agrees to allow interviews with owners, principals, o'icers, 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 o'icer or employee of the City. A Prime
Bidder/O'eror 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 di'erent)
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
File details come from the government source that posted it. Updated .