Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFP PS-26-0128
- 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 Compliance Section for use by prime contractors managing Disadvantaged Business Enterprise (DBE) subcontractors on federally-assisted transit projects. The form permits prime contractors to request approval for specific modifications to their DBE utilization, including release of proposed DBE subcontractors, substitution of DBE subcontractors, changes to the scope of work performed by DBE subcontractors, or reduction of amounts originally proposed for DBE subcontractors. All requests must be submitted to the City of Phoenix Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes. The form requires the authorized representative of the prime contractor to provide detailed information regarding the affected DBE subcontractor(s), the scope of work to be performed, a summary of the exemption request, and documentation of good faith efforts undertaken to locate additional DBE participation. No DBE substitution, termination, scope reduction, or amount modification is permitted without formal written approval from the Compliance Section.
The form includes sections for contract compliance use only, where the City's Contract Compliance Specialist reviews and approves or denies the request, documents the revised DBE goal and revised DBE utilization percentage, and maintains supporting documentation including the Initial SBPP Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment. This administrative process ensures compliance with 49 CFR Part 26 DBE requirements applicable to federally-funded transportation projects and maintains accountability for minority and women-owned business participation throughout the contract lifecycle.
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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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