Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFP GGS-26-0117
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form used by the City of Phoenix Public Transit Department to manage Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form serves as the official mechanism for prime contractors to request approval before modifying their proposed DBE utilization, including releasing proposed DBE subcontractors, substituting existing DBE subcontractors, changing the scope of work assigned to DBE subcontractors, or reducing the proposed amounts for DBE subcontractors. All requests must be submitted to the City of Phoenix Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any changes. The form requires the prime contractor's authorized representative to certify their authority and summarize the good faith efforts undertaken to secure alternative DBE participation, with supporting documentation attached as necessary.
The form includes fields for contract identification, affected DBE subcontractor information, scope of work details, and the specific type of exemption or substitution being requested. Upon submission, the City's Contract Compliance Section reviews the request and documents approval status, revised DBE goals, revised DBE utilization percentages, and the assigned compliance specialist. The form references supporting exhibits including the Initial SBPP Plan, DBE Annual SBPP Plan, Certification of Final Payment, and related DBE documentation. This administrative process ensures that any modifications to DBE commitments comply with federal disadvantaged business enterprise requirements and maintain transparency in the utilization of certified DBE firms on City of Phoenix contracts.
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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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