Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Part-Time Television Engineering Services
- Solicitation number
- IFB-26-0141
- 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 managing Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form serves as the official mechanism for prime contractors to request approval for releasing proposed DBE subcontractors, substituting existing DBE subcontractors, changing the scope of work assigned to DBE subcontractors, or reducing the financial amount originally proposed for DBE participation. Contractors must submit the completed form to the City's Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any modifications to their stated DBE utilization. The form requires the prime contractor's authorized representative to certify their authority to request the exemption and to document the good faith efforts undertaken to secure additional DBE participation as an alternative to the requested substitution or exemption.
The form prohibits any substitution, termination, or scope reduction of DBE subcontractors without prior written approval from the Compliance Section. The document includes a section for contract compliance use only, where the Compliance Section documents whether the request was approved, the revised DBE goal percentage, the revised DBE utilization percentage, and the assigned Contract Compliance Specialist. Supporting documentation and exhibits required for the evaluation process include the Initial Small Business Participation Program (SBPP) Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment. This exemption and substitution process is part of the City of Phoenix's adherence to 49 CFR Part 26 regulations governing federal transit funding and DBE participation requirements.
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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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