Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Heat Relief Supply Distribution Management
- Solicitation number
- RFP GGS-26-0100
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form used by the City of Phoenix Public Transit Department to manage Disadvantaged Business Enterprise (DBE) participation changes on contracts. The form must be submitted to the City's Compliance Section for approval prior to implementing any modifications to proposed DBE utilization. The document allows prime contractors to request exemptions for releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work assigned to DBE subcontractors, or reducing amounts originally proposed for DBE subcontractors. Contractors must document good faith efforts in identifying additional DBE participation when requesting exemptions, with supporting documentation required as necessary. The form requires authorization from a duly authorized representative of the prime contractor and includes fields for the contract number, project description, affected DBE subcontractor information, and the scope of work to be performed. The City's Contract Compliance Section completes the reverse side of the form, documenting approval status, revised DBE goals, revised DBE utilization percentages, and assigning a compliance specialist.
For the related Heat Relief Supply Distribution Management contract (GGS-26-0100), the City of Phoenix established specific DBE and small business participation requirements under the United States Department of Transportation's DBE program. Contractors must demonstrate good faith efforts to promote small business and DBE firm participation, including sending outreach letters and making reasonable efforts to utilize DBE business services. Monthly documentation of DBE and small business participation is required through the City's Certification and Compliance System. The contract runs for a five-year term beginning February 1, 2026, with an estimated 5,000 annual hours at a unit hourly rate for a Heat Relief Supply Distribution Manager. Insurance requirements include $2,000,000 general liability, $1,000,000 automobile liability, and workers' compensation coverage. The procurement was released September 16, 2025, with a pre-offer conference scheduled for September 23, 2025, at 9:30 a.m., and proposals due October 15, 2025, at 2:00 p.m.
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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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