Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Youth Crime Prevention Program
- Solicitation number
- HSD-RFP-26-0074
- 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 managing Disadvantaged Business Enterprise (DBE) participation on city contracts. The form must be submitted to the City of Phoenix Public Transit Department Compliance Section prior to making any changes to proposed DBE utilization statements. The document allows prime contractors to request exemptions or substitutions related to DBE subcontractors, 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. Contractors must provide documentation of good faith efforts undertaken to secure additional DBE participation when requesting exemptions. The form requires authorization from a duly authorized representative of the prime contractor and includes fields for contract number, project description, affected DBE subcontractor information, and scope of work details.
The form is designed for administrative compliance purposes and contains a section for Contract Compliance Specialist review and approval, including fields for documenting revised DBE goals and utilization percentages. All requests must include supporting documentation and additional pages as necessary to demonstrate the contractor's efforts in seeking DBE participation. The form serves as a critical control mechanism for the City of Phoenix to ensure compliance with DBE requirements and to maintain transparency in subcontractor participation throughout the contract term. No changes to DBE participation may be implemented without prior written approval from the Compliance Section.
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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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