Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- AVN IFB-26-0125
- 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 that governs modifications to Disadvantaged Business Enterprise (DBE) utilization on state and local contracts. The form must be submitted to the Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any changes to proposed DBE utilization statements or contractors' monthly DBE utilization reports. The form allows prime contractors to request approval for four specific actions: releasing a proposed DBE subcontractor, substituting an existing DBE subcontractor, changing the scope of work performed by a DBE subcontractor, or reducing the amount originally proposed for a DBE subcontractor. Requestors must provide detailed justification for the exemption request, including documentation of good faith efforts made to secure additional DBE participation. The form requires authorization by a duly authorized representative of the prime contractor and must be accompanied by supporting documentation as necessary.
Upon submission, the City's Contract Compliance Section reviews the request and documents its decision, including the request approval status, any revisions to the DBE goal, revised DBE utilization percentages, and the assigned Contract Compliance Specialist responsible for the review. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without explicit approval from the Compliance Section. This procedural requirement ensures compliance with federal and local DBE program requirements and maintains accountability in the utilization of certified disadvantaged business enterprises 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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