Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Evidence Bags
- Solicitation number
- IFB-26-0116
- 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 to manage changes to Disadvantaged Business Enterprise (DBE) utilization on contracts. The form enables prime contractors to request approval for releasing proposed DBE subcontractors, substituting DBE subcontractors, modifying the scope of work performed by DBE subcontractors, or reducing the proposed amounts for DBE subcontractors. All requests must be submitted to ptdcompliance@phoenix.gov prior to implementing any changes to the proposed statement of DBE utilization or the contractor's monthly DBE utilization statement. The form requires the prime contractor's duly authorized representative to document the good faith efforts undertaken to identify additional DBE participation, with supporting documentation attached as necessary. The City's Contract Compliance Section reviews submitted requests and determines approval status, revised DBE goals, and revised DBE utilization percentages.
In accordance with 49 CFR Part 26, the form applies to Federal Transit Administration-assisted projects and enforces strict controls over DBE subcontractor modifications. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without explicit written approval from the Compliance Section. The form serves as a critical compliance document ensuring that contractors maintain their DBE commitments or provide documented justification for any requested deviations, thereby protecting the integrity of the Small Business Participation Plan and federal transit funding requirements applicable to the City of Phoenix's procurement activities.
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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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