Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- 24-Hour Answering Service
- Solicitation number
- PKS-RFP-27-0440
- 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 in connection with Disadvantaged Business Enterprise (DBE) utilization requirements on transit-related contracts. The form serves as the official mechanism for prime contractors to request approval for modifications to their proposed DBE participation, including the release of proposed DBE subcontractors, substitution of DBE subcontractors, changes to the scope of work assigned to DBE subcontractors, or reductions to amounts originally proposed for DBE subcontractors. All requests must be submitted to the Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes. The form requires documentation of good faith efforts undertaken by the prime contractor to identify additional DBE participation and must be signed by a duly authorized representative of the prime contractor.
The form designates specific fields for contract identification, affected DBE subcontractor information, scope of work details, and a checkbox matrix indicating the type of exemption or substitution being requested. The Compliance Section reserves the authority to approve or deny requests and may establish revised DBE goals and utilization percentages as a condition of approval. A designated Contract Compliance Specialist reviews all submissions and maintains supporting documentation including the initial and annual Small Business Procurement Plan (SBPP) and DBE certification of final payment records. The form emphasizes that no DBE substitution, termination, scope reduction, or proposed amount modification may occur without prior written approval from the Compliance Section.
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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 .