Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Evidence Bags
- Solicitation number
- IFB-26-0116
- 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 request approval for changes to Disadvantaged Business Enterprise (DBE) utilization on contracts. The form allows prime contractors to request exemptions for releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work for DBE subcontractors, or reducing the amount originally proposed for DBE subcontractor participation. Contractors must submit the completed form to the City of Phoenix Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to making any changes to their proposed DBE utilization statement. The form requires the prime contractor's duly authorized representative to provide detailed justification for the requested exemption, including a summary of good faith efforts made to identify additional DBE participation, with supporting documentation attached as necessary. The Contract Compliance Section reviews and approves or denies requests, documenting the decision with the contract and project information, revised DBE goals, revised DBE utilization percentages, and the assigned compliance specialist.
This form is specifically applicable to the City of Phoenix's Evidence Bags procurement (IFB-26-0116) for the Police Department, which is subject to Federal Transit Administration requirements under 49 CFR Part 26 mandating DBE participation and Small Business Participation Plans. All contractors on this contract must demonstrate good faith efforts in identifying and tracking DBE-certified firm participation. The form serves as the mechanism through which contractors can request relief from initial DBE commitments if they can document that adequate DBE firms were not available or responsive, ensuring compliance with federal regulations while allowing flexibility when legitimate circumstances prevent DBE utilization.
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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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