Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Odor Control Services
- Solicitation number
- IFB-26-0067
- 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 state and local contracts involving Disadvantaged Business Enterprise (DBE) utilization requirements. The form is designed to be submitted to the City of Phoenix Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to any modifications to proposed DBE utilization statements or contractor monthly DBE utilization forms. The document establishes the procedural framework for requesting approval to release proposed DBE subcontractors, substitute DBE subcontractors, modify the scope of work performed by DBE subcontractors, or reduce amounts originally proposed for DBE subcontractors. The form requires authorization from a duly authorized representative of the prime contractor and mandates documentation of good faith efforts undertaken in sourcing additional DBE participation.
The form includes designated sections for prime contractor identification, contract and project numbers, affected DBE subcontractor information, and scope of work descriptions. The compliance review section requires documentation of the exemption request rationale and good faith efforts summary, with provisions for additional supporting documentation as necessary. Upon completion of the compliance review process, the Contract Compliance Specialist must approve or deny the request, establish any revised DBE goals and utilization percentages, and reference supporting exhibits including the Initial SBPP Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment. This form applies to the City's Odor Control Services contract, a five-year agreement commencing on or about July 1, 2026.
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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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