Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- HVAC Filter Maintenance and Repair
- Solicitation number
- 27-FMD-007
- 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's Compliance Section for managing Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form permits prime contractors to request approval for releasing proposed DBE subcontractors, substituting existing DBE subcontractors, modifying the scope of work assigned to DBE subcontractors, or reducing the dollar amount originally proposed for DBE participation. Contractors must demonstrate good faith efforts in identifying replacement DBE participation and must submit the request with supporting documentation prior to implementing any changes. The form requires authorization by a duly authorized representative of the prime contractor and includes designated fields for contract number, project description, affected DBE subcontractors, and the specific scope of work being modified. The City's Contract Compliance Section reviews all submissions and maintains authority to approve or deny requests, adjusting the DBE goal and utilization percentages as appropriate.
The compliance process is mandatory under the City of Phoenix's DBE participation requirements aligned with 49 C.F.R. Part 26 federal regulations. All requests must include detailed justification and documentation of good faith efforts to secure alternative DBE participation before substitutions or exemptions are granted. The form serves as an official record in the City's Certification and Compliance System portal and must be completed by the prime contractor's authorized agent with phone contact information and signature. Contract Compliance Specialists assigned to the project are responsible for review, approval determination, and recording of revised DBE goals and utilization percentages in the contract file.
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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: |
File details come from the government source that posted it. Updated .