Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Alco-Sensor Equipment, Parts and Supplies
- Solicitation number
- IFB-26-0123
- 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 Compliance Section for use by prime contractors seeking approval to modify Disadvantaged Business Enterprise (DBE) subcontractor participation on awarded contracts. The form permits authorized representatives of prime contractors to request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work for DBE subcontractors, or reduce the originally proposed amounts for DBE subcontractors. All requests must be submitted to ptdcompliance@phoenix.gov prior to implementing any changes and must include a summary of the prime contractor's good faith efforts in locating additional DBE participation. The form requires the contractor to provide the contract number, project number and description, identification of affected DBE subcontractors, and documentation of the scope of work to be performed, with additional supporting documentation attached as necessary.
Upon receipt, the City of Phoenix Contract Compliance Section reviews the submission and provides approval or denial, noting the request approval status, revised DBE goal percentage, and revised DBE utilization percentage. The form serves as the official mechanism for contractors to seek relief from DBE utilization commitments made during the original proposal phase while ensuring the City maintains oversight of small business participation in Public Transit Department-funded contracts in accordance with 49 CFR Parts 26 and 23. Compliance documentation, including the initial SBPP Plan, DBE Annual SBPP Plan, and Certification of Final Payment, must accompany the request to support the contractor's exemption justification.
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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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