Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFP PS-26-0128
- 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 Compliance Section for use by prime contractors on City projects subject to Disadvantaged Business Enterprise (DBE) requirements. The form is designed to request approval for releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work performed by DBE subcontractors, or reducing the amount originally proposed for DBE subcontractors. Prime contractors must submit completed forms to ptdcompliance@phoenix.gov prior to implementing any changes to their proposed statement of DBE utilization or to their contractor's monthly statement of DBE utilization form. The form requires the duly authorized representative of the prime contractor to certify their authority to request the exemption and to summarize the prime contractor's request along with the good faith efforts made in finding additional DBE participation, with provisions for attaching additional pages and supporting documentation as necessary. The City's Contract Compliance Section reviews all submissions and indicates approval status, revised DBE goals, revised DBE utilization percentages, and the assigned compliance specialist responsible for oversight.
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 City of Phoenix Public Transit Department Compliance Section. This form is a mandatory compliance document applicable to all federally-assisted transit projects under 49 CFR Part 26, ensuring that contractors maintain compliance with DBE participation requirements throughout the contract term and preventing unilateral modifications to DBE commitments made during the proposal phase.
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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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