City of Fort Worth - Business Equity Division
1150 South Freeway | Fort Worth | TX | 76104 | Office: (817) 392-2674
Certified M/WBE Firms for Goods and Services
Request for Listing
PLEASE ANSWER ALL QUESTIONS ON THIS FORM TO ENSURE FASTER PROCESSING
COMPANY NAME: ___________________________________________________________________________________________
ADDRESS: _________________________________________________________________________________________________
CITY/STATE/ZIP: ____________________________________________________________________________________________
REQUESTER’S NAME: _______________________________________________________________________________________
PHONE: ____________________ FAX: _____________________ EMAIL: _____________________________________________
IS THIS A CITY OF FORT WORTH FUNDED PROJECT?
YES NO IF YES, PLEASE PROVIDE PROJECT NAME
_______
____________________________________________________________________________________________________
IS THIS A FEDERALLY FUNDED PROJECT? YES NO IF YES, PLEASE PROVIDE PROJECT NAME
___________________________________________________________________________________________________________
BID OPENING DATE: _____________________ OR PROJECT DATE: ___________________________
YOUR REQUEST WILL BE RETURNED TO YOU VIA EMAIL UNLESS OTHERWISE SPECIFIED
SPECIFY OTHER: ___________________________________________________
This listing inclusive of the commodities you requested can be utilized for two months from the date of this letter as
outlined in the Business Diversity Ordinance #20020-12-2011. If additional commodities are needed within this two
month period please email your request to the Office of Business Diversity at: mwbeoffice@fortworthtexas.gov.
