Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFP 27-SWDD-006
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form from the City of Phoenix Public Transit Department, designed to facilitate changes to Disadvantaged Business Enterprise (DBE) utilization on state and local contracts. The form allows prime contractors to request approval from the City's Compliance Section prior to making modifications to their proposed DBE utilization statements. Specifically, contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work for DBE subcontractors, or reduce the amount originally proposed for DBE subcontractors. All requests require submission to ptdcompliance@phoenix.gov and must be accompanied by documentation of good faith efforts to secure alternative DBE participation. The form requires authorization by a duly authorized representative of the prime contractor and includes designated fields for contract number, project description, affected DBE subcontractors, scope of work, and supporting documentation.
The form is processed exclusively by the City's Contract Compliance Section, which reviews each request and determines approval status, revised DBE goals, and revised DBE utilization percentages. While the form itself does not establish pricing terms or specific funding requirements, it operates within the broader framework of the City of Phoenix's commitment to DBE participation and small business engagement. The compliance process ensures that any substitutions or exemptions align with federal, state, and local regulations governing disadvantaged business utilization on public works projects. No changes to DBE participation may be implemented without formal written approval from the Contract Compliance Specialist, maintaining accountability and transparency throughout the contract administration process.
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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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