Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Print and Mail Election Materials
- Solicitation number
- RFP GGS-26-0079
- 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 managing Disadvantaged Business Enterprise (DBE) subcontractor changes on city contracts. The form serves as the official mechanism for prime contractors to request approval for releasing proposed DBE subcontractors, substituting DBE firms, modifying scopes of work, or adjusting compensation amounts 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 DBE utilization statement or monthly DBE participation documentation. The form requires the authorized representative of the prime contractor to identify the affected DBE subcontractor(s), describe the scope of work, explain the specific type of change being requested, and provide documentation of good faith efforts undertaken to identify alternative DBE participation. The City's Contract Compliance Section reviews each submission and indicates approval status, revised DBE goals, revised utilization percentages, and the assigned compliance specialist on the form.
The form emphasizes that no DBE substitution, termination, scope reduction, or amount modification may occur without prior written approval from the Compliance Section. Applicants must demonstrate good faith efforts in attempting to secure replacement DBE participation before requesting exemptions. The form requires supporting documentation to be attached, allowing for comprehensive evaluation of the contractor's diligence in maintaining DBE participation commitments. This procedural requirement aligns with the City of Phoenix's commitment to Disadvantaged Business Enterprise participation mandates established under United States Department of Transportation guidelines, ensuring transparent tracking and documentation of all subcontractor modifications throughout the contract term.
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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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