Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- 35-65-95 Gallon Containers
- Solicitation number
- RFP 27-SW-001
- 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) utilization on city contracts. The form requires submission to the Public Transit Department Compliance Section prior to implementing changes to proposed DBE utilization statements or contractor monthly DBE reporting forms. Prime contractors may request exemptions for four categories of modifications: releasing a proposed DBE subcontractor, substituting a DBE subcontractor, changing the scope of work for a DBE subcontractor, or reducing the amount originally proposed for a DBE subcontractor. The form requires the authorized representative of the prime contractor to certify their authority, specify which exemptions are being requested, and provide a detailed summary of the contractor's good faith efforts in locating additional DBE participation, with supporting documentation attached as necessary. All requests require formal approval from the Contract Compliance Section before implementation.
The City of Phoenix reserves the right to approve or deny all substitution and exemption requests, and upon approval, will document the revised DBE goals and utilization percentages on the form. This administrative process is mandatory for any modifications to DBE subcontracting arrangements on city contracts funded by federal transit dollars, ensuring compliance with federal Disadvantaged Business Enterprise participation requirements and promoting equitable business opportunities for certified disadvantaged business enterprises throughout the procurement and contract execution process.
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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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