Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Alco-Sensor Equipment, Parts and Supplies
- Solicitation number
- IFB-26-0123
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form from the City of Phoenix Public Transit Department used to manage Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form allows prime contractors to request approval for releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work performed by DBE subcontractors, or reducing amounts originally proposed for DBE subcontractors. All requests must be submitted to the City's Public Transit Department Compliance Section prior to implementing any changes to the DBE utilization statement. The form requires the prime contractor's authorized representative to document the exemption request, summarize good faith efforts undertaken to secure additional DBE participation, and provide supporting documentation as necessary. The City's Contract Compliance Section reviews and approves requests, noting the revised DBE goal and utilization percentages on the form.
This administrative form serves as a control mechanism within the City of Phoenix's DBE participation program, which operates under 49 CFR Parts 26 and 23. No DBE subcontractor may be substituted, terminated, or have their scope of work reduced or proposed amount changed without written approval from the Compliance Section. The form includes designated spaces for the prime contractor's contract number, project description, affected DBE subcontractor information, and the nature of the requested exemption, along with signature blocks for both the contractor's authorized agent and the City's Contract Compliance Specialist. This procedural document ensures compliance with federal disadvantaged business enterprise requirements and maintains accountability in subcontractor utilization across City of Phoenix procurement activities.
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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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