Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Solicitation number
- RFQu-26-0091
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
Request for Substitution/Exemption Form - City of Phoenix Public Transit Department
This is a Request for Substitution/Exemption form issued by the City of Phoenix Public Transit Department Compliance Section for management of Disadvantaged Business Enterprise (DBE) participation on public transit contracts. The form allows prime contractors to request approval for modifications to their DBE utilization plans, including release of proposed DBE subcontractors, substitution of DBE subcontractors, changes to DBE subcontractor scope of work, or reductions to originally proposed DBE subcontractor amounts. All requests must be submitted to the Compliance Section at ptdcompliance@phoenix.gov prior to implementation. The form requires the authorized representative of the prime contractor to certify their authorization to request exemptions and to provide documentation of good faith efforts undertaken to locate additional DBE participation. Upon submission, the Contract Compliance Section reviews the request and determines whether approval should be granted, noting the revised DBE goal and utilization percentage.
The form serves as a compliance mechanism for federally-funded FTA projects, which require adherence to 49 CFR Part 26 DBE program requirements. No DBE subcontractor may be substituted, terminated, or have their scope of work reduced or proposed amount modified without explicit written approval from the Compliance Section. Contractors must maintain comprehensive supporting documentation demonstrating legitimate business reasons and good faith efforts in seeking replacement DBE participation. The form contains designated spaces for contract number, project description, affected DBE subcontractor identification, and detailed scope of work specifications, along with signature lines for contractor authorization and compliance specialist approval, ensuring full accountability and transparency in all DBE utilization modifications 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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