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

Summary

This is a Request for Substitution/Exemption form issued by the City of Phoenix Public Transit Department Compliance Section for use by prime contractors seeking approval to modify Disadvantaged Business Enterprise (DBE) utilization on federally-assisted transit contracts. The form permits contractors to request exemptions for releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work for DBE subcontractors, or reducing amounts originally proposed for DBE participation. All requests must be submitted to ptdcompliance@phoenix.gov prior to implementing any changes to the proposed DBE utilization statement or the contractor's monthly DBE utilization form. The form requires the prime contractor's authorized representative to certify the request, provide a summary of good faith efforts in identifying additional DBE participation, and submit supporting documentation as necessary. The City's Contract Compliance Section reviews all submissions and indicates approval status, revised DBE goals, and revised DBE utilization percentages on the form.

The form serves as a control mechanism ensuring that no DBE subcontractor substitutions, terminations, scope reductions, or payment amount modifications occur without formal written approval from the City's Compliance Section. This requirement applies to contracts subject to 49 CFR Part 26 compliance obligations, which mandate that contractors demonstrate good faith efforts in achieving DBE participation goals throughout contract performance. The form requires documentation of the prime contractor's efforts to locate replacement DBE firms before exemptions are granted, ensuring that reductions in DBE utilization do not occur without legitimate justification and demonstrated diligent solicitation efforts.

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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:

File details come from the government source that posted it. Updated .