Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFP PS-26-0128
- 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 their Disadvantaged Business Enterprise (DBE) utilization commitments. The form requires submission to the City's Compliance Section prior to implementing any changes to proposed DBE participation or monthly utilization statements. Prime contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work performed by DBE subcontractors, or reduce amounts originally proposed for DBE subcontractors. The form requires the authorized representative of the prime contractor to document good faith efforts and supporting justification for the requested exemption, with detailed explanations and supplementary documentation attached as necessary. The City's Contract Compliance Section reviews and approves all requests, documenting the decision, revised DBE goals, revised DBE utilization percentages, and the reviewing compliance specialist's information on the form.
This form is mandatory for any modifications to DBE participation on City of Phoenix contracts subject to 49 CFR Part 26 requirements applicable to Federal Transit Administration-assisted projects. No DBE shall be substituted, terminated, or have their scope of work reduced or proposed amount changed without explicit written approval from the Compliance Section. The form serves as the administrative mechanism ensuring compliance with federal nondiscrimination and small business participation mandates while providing contractors with a formal process to address workforce challenges or project circumstances that may necessitate changes to their original DBE commitments.
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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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