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 from the City of Phoenix Public Transit Department that outlines the process for contractors to request approval for changes to Disadvantaged Business Enterprise (DBE) utilization. The form must be submitted to the City's Compliance Section prior to implementing any modifications to proposed DBE participation. Prime contractors are authorized to request exemptions or substitutions related to DBE subcontractors, including releasing a proposed DBE subcontractor, substituting one DBE subcontractor for another, changing the scope of work for a DBE subcontractor, or reducing the amount originally proposed for DBE participation. The form requires the contractor's authorized representative to provide a summary of good faith efforts undertaken to secure additional DBE participation, supported by relevant documentation. The request is then reviewed and approved or denied by the City's Contract Compliance Specialist, who documents the decision, revised DBE goals, and revised DBE utilization percentages.
The form serves as a critical compliance mechanism for the City of Phoenix's DBE program, which operates under 49 CFR Parts 26 and 23, requiring contractors to demonstrate commitment to small business and minority participation throughout contract performance. No DBE subcontractor may be substituted or terminated, nor may their scope of work be reduced or proposed amount changed without explicit written approval from the Compliance Section. This requirement applies to all contracts subject to the City's Small Business Participation Plan requirements, ensuring ongoing oversight and accountability in DBE utilization from contract initiation through completion.
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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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