Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- 35-65-95 Gallon Containers
- Solicitation number
- RFP 27-SW-001
- 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) utilization on public transit contracts. The form serves as the official mechanism for prime contractors to request approval for modifications to their proposed DBE participation, including release of proposed DBE subcontractors, substitution of DBE firms, changes to the scope of work assigned to DBE subcontractors, or reduction of amounts originally proposed for DBE subcontractors. All requests must be submitted to the City's Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes. The form requires prime contractors to document good faith efforts undertaken in attempting to secure additional DBE participation and necessitates authorization signatures from duly authorized contractor representatives. The City's Contract Compliance Section reviews submissions and indicates approval status, revised DBE goals, and revised DBE utilization percentages.
The form includes provisions for attachment of supporting documentation and requires contractors to demonstrate adequate justification for any requested modifications to DBE participation commitments. Approvals are contingent upon the City's determination that good faith efforts have been made and that exemptions are warranted. The form structure indicates integration with the City's broader Small Business Participation Plan (SBPP) requirements, which mandate tracking and reporting of monthly DBE and small business utilization across all covered contracts. This administrative process ensures compliance with federal transit funding guidelines that require contractors to actively promote and document participation of certified disadvantaged and small business enterprises throughout contract performance.
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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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