Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Valves
- Solicitation number
- IFB-26-0134
- 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 Disadvantaged Business Enterprise (DBE) utilization on state and local contracts. The form serves as the official mechanism through which prime contractors may request approval to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work performed by DBE subcontractors, or reduce the amount originally proposed for DBE subcontractors. All requests must be submitted to the City of Phoenix Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes to the proposed statement of DBE utilization or the contractor's monthly statement of DBE utilization form. The form requires the duly authorized representative of the prime contractor to provide detailed information including the contract number, project number and description, affected DBE subcontractor(s), scope of work to be performed, and a comprehensive summary of the prime contractor's request for exemption along with documentation of good faith efforts made to secure additional DBE participation.
The form includes designated sections for the City's Contract Compliance Section to review and approve or deny the request, with fields to document the contract compliance specialist's determination, revised DBE goals, and revised DBE utilization percentages. All submissions must be accompanied by supporting documentation and exhibit materials, including the Initial SBPP Plan, DBE Annual SBPP Plan, and certification of final payment as applicable. No DBE substitution, termination, scope reduction, or amount modification is permitted without explicit written approval from the Compliance Section, ensuring strict adherence to Federal Transit Administration regulations governing DBE participation requirements on City of Phoenix contracts.
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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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