Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- HVAC Filter Maintenance and Repair
- Solicitation number
- 27-FMD-007
- 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 use in connection with Disadvantaged Business Enterprise (DBE) participation requirements on state and local contracts. The form is submitted to the City's Public Transit Department Compliance Section prior to making any changes to proposed DBE utilization statements. Prime contractors may request exemptions or substitutions related to DBE subcontractors, including releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work performed by DBE subcontractors, or reducing amounts originally proposed for DBE subcontractors. The form requires the authorized representative of the prime contractor to document good faith efforts in finding additional DBE participation and provide supporting documentation as necessary. Contract compliance specialists review and approve requests, noting the revised DBE goal and revised DBE utilization percentages.
The form establishes a formal approval process ensuring that no DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without prior written approval from the Compliance Section. This requirement applies to all contracts subject to City of Phoenix DBE participation plans, which comply with 49 C.F.R. Part 26 and require contractors to maintain documentation of good faith efforts to engage DBE-certified suppliers. The form serves as the primary mechanism for managing changes to DBE commitments throughout contract performance and ensures transparency and compliance with federal disadvantaged business enterprise regulations.
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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: |
File details come from the government source that posted it. Updated .