Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFQu-26-0091
- 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 by prime contractors seeking approval to modify Disadvantaged Business Enterprise (DBE) subcontractor commitments on federally-assisted transit contracts. The form requires submission to the Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any changes to proposed DBE utilization statements or monthly reporting. Prime contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, modify the scope of work assigned to DBE subcontractors, or reduce the amounts originally proposed for DBE participation. The form requires the duly authorized representative of the prime contractor to document the specific request, provide a summary of good faith efforts undertaken to secure additional DBE participation, and attach supporting documentation as necessary. Upon submission, the Contract Compliance Section reviews the request and indicates approval status, revised DBE goals, revised DBE utilization percentages, and the assigned compliance specialist's contact information.
The form operates within the regulatory framework of 49 CFR Part 26, which mandates DBE participation requirements for contractors on Federal Transit Administration-assisted projects. No substitution, termination, scope reduction, or amount modification may occur without prior written approval from the City's Compliance Section. The form serves as the official mechanism for documenting changes to contractual DBE commitments and maintaining compliance with federal and local participation requirements throughout the contract performance period.
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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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