Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- RFQu-26-0091
- 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 Disadvantaged Business Enterprise (DBE) subcontractor participation on contracts. The form requires submission to the City's Compliance Section prior to implementing any changes to the proposed DBE utilization statement or the contractor's monthly DBE utilization documentation. Prime contractors may use this form to request exemptions for releasing a proposed DBE subcontractor, substituting a DBE subcontractor, changing the scope of work assigned to a DBE subcontractor, or reducing the amount originally proposed for DBE subcontractor participation. The form requires the authorized representative of the prime contractor to provide a detailed summary of the exemption request and document the good faith efforts undertaken to secure additional DBE participation. The Compliance Section must approve all requests prior to implementation, and no DBE substitution, termination, scope reduction, or amount modification may occur without written authorization.
The form serves as an administrative tool for managing DBE compliance on Federal Transit Administration (FTA)-assisted projects subject to 49 CFR Part 26 requirements. All requests must include supporting documentation and may require additional pages if necessary. The Compliance Section will review each submission and determine whether to approve the request, and if approved, will specify any revised DBE goals and utilization percentages. This form is part of the City's broader Small Business Participation Plan (SBPP) and DBE certification process for contractors, ensuring ongoing monitoring and documentation of disadvantaged and small business participation throughout contract performance.
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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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