Attachment_-_Request_for_Substitution_-_Exemption.pdf

PDF 102 KB Posted

Attached to
Parts, Installation and Service for Direct Current Batteries and Power Plants
Solicitation number
IFB-26-0107
Issued by
Maricopa County, Phoenix City, Arizona

About this file

Written by GovTribe AI ·

This is a Request for Substitution/Exemption form issued by the City of Phoenix Public Transit Department for use in managing Disadvantaged Business Enterprise (DBE) participation on local contracts. The form allows prime contractors to request approval from the City's Compliance Section prior to making changes to their proposed DBE utilization, including releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work for DBE subcontractors, or reducing the amount originally proposed for DBE participation. All requests must include documentation of good faith efforts made to find additional DBE participation and must be submitted to ptdcompliance@phoenix.gov for approval before implementation. The form requires authorized signatures from the prime contractor's representative and includes fields for the Contract Number, Project Number and Description, affected DBE subcontractor information, and scope of work details.

The form designates a section for City of Phoenix Contract Compliance use only, where a Compliance Specialist documents the decision regarding the request, including approval status, revised DBE goals, and revised DBE utilization percentages. The document serves as a control mechanism to ensure that DBE participation goals established during the initial contract bidding process are maintained throughout contract performance, or that any modifications are formally documented and justified through demonstrated good faith outreach efforts by the prime contractor.

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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 .