Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Organizational Change Management Service
- Solicitation number
- RFQu-26-0077
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form issued by the City of Phoenix Public Transit Department for managing Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form must be submitted to the Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any modifications to DBE utilization statements. Prime contractors may request exemptions to release proposed DBE subcontractors, substitute existing DBE subcontractors, modify the scope of work performed by DBE subcontractors, or reduce the proposed amounts for DBE subcontractors. The authorized prime contractor representative must certify their authority to submit the request and provide a detailed summary of the exemption rationale and good faith efforts undertaken to secure additional DBE participation. The form includes designated spaces for the contractor to provide supporting documentation, contact information, and authorization signatures.
The Compliance Section review process requires formal approval before any DBE changes are implemented and includes fields for documenting the revised DBE goals and utilization percentages upon approval. The form serves as a mandatory compliance mechanism to ensure adherence to federal DBE participation requirements under 49 CFR Part 26 and maintains documentation of all substitutions, exemptions, and scope modifications throughout the contract execution period. The related City of Phoenix Water Services Department Organizational Change Management Services solicitation (RFQu-26-0077) similarly requires demonstration of good faith efforts in promoting DBE and small business participation through proactive outreach and identification of certified suppliers using Arizona UTRACS and City of Phoenix databases, indicating consistent application of these requirements across City departments.
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Text version
City of Phoenix
PUBLIC TRANSIT DEPARTMENT
REQUEST FOR SUBSTITUTION/EXEMPTION
This form must be submitted to the City of Phoenix, Public Transit Department Compliance Section (ptdcompliance@phoenix.gov), for approval prior to making any changes to the proposed statement of DBE utilization or Contractor’s monthly statement of DBE utilization form. No DBE shall be substituted or terminated, nor shall their scope of work be reduced or proposed amount changed without the approval of the Compliance Section.
Prime Contractor: Contract Number:
Project Number and Description:
Affected DBE Subcontractor(s):
Scope of Work to be Performed by Affected DBE Subcontractors(s):
1. I am the duly authorized representative of the above listed Prime Contractor and am authorized to request this exemption on behalf of the Prime Contractor.
2. I hereby request that an exemption be granted to the above-mentioned Prime Contractor to (check those that apply):
Release proposed DBE subcontractor Substitute DBE subcontractor
Change scope of work to be performed by DBE subcontractor
Reduce amount originally proposed for DBE subcontractor
3. I have summarized the Prime Contractor's request for an exemption and the good faith efforts required in finding additional DBE participation on the above-mentioned contract as follows: (Attach additional pages and supporting documentation as necessary.)
Date:
Phone:
Yes No %
Date:
Authorized Signature:
Signature of Authorized Agent for Contractor
Name and Title:
FOR CONTRACT COMPLIANCE USE ONLY
Request Approved: Revised DBE Goal:
Revised DBE Utilization:
Contract Compliance Specialist:
| Exhibit - Initial SBPP Plan |
| Exhibit - DBE Annual SBPP Plan |
| Exhibit - DBE Request for Substitution or Exemption |
| Exhibit - DBE Certification of Final Payment |
| Phone: |
| Prime Contractor: |
| Contract Number: |
| Project Number and Description: |
| Affected DBE Subcontractors: |
| Scope of Work to be Performed by Affected DBE Subcontractorss: |
| to check those that apply: |
| Substitute DBE subcontractor: |
| undefined: |
| proposed for DBE: |
| follows Attach additional pages and supporting documentation as necessary: |
| Name and Title: |
| FOR CONTRACT COMPLIANCE USE ONLY: |
| No: |
| Date_2: |
| Text39: |
| Text40: |
| Text41: |
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