Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Hydrochloric and Citric Acid
- Solicitation number
- IFB-26-0146
- 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 to manage Disadvantaged Business Enterprise (DBE) subcontractor changes on transit contracts. The form must be submitted to the Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any modifications to proposed DBE utilization statements or monthly DBE utilization reports. Prime contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work assigned to DBE subcontractors, or reduce the dollar amounts originally proposed for DBE participation. The form requires the duly authorized representative of the prime contractor to provide the contract number, project number and description, identification of affected DBE subcontractor(s), scope of work details, and a comprehensive summary of the exemption request including documentation of good faith efforts made to secure additional DBE participation.
The form requires submission with the authorized signature, date, phone number, name and title of the contractor's authorized agent. Upon receipt, the City of Phoenix Contract Compliance Section reviews the request and determines approval or denial, noting the revised DBE goal and revised DBE utilization percentage if the request is approved. A Contract Compliance Specialist completes the compliance review section of the form, including the approval decision date. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed contract amount modified 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: |
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