Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Solicitation number
- RFP 27-SWDD-006
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
The document is a Request for Substitution/Exemption form from the City of Phoenix Public Transit Department, designed to manage Disadvantaged Business Enterprise (DBE) subcontractor changes. The form is used by prime contractors to request approval from the City of Phoenix Public Transit Department Compliance Section for modifications to DBE utilization, including releasing, substituting, changing the scope of work, or reducing the amount proposed for a DBE subcontractor.
The form requires the prime contractor to provide details about the proposed changes and demonstrate good faith efforts in finding additional DBE participation. Submission must be made to ptdcompliance@phoenix.gov prior to implementing any changes. The Compliance Section will review the request and determine whether to approve the modifications, potentially adjusting the DBE goal and utilization percentage. The form includes sections for the contractor to specify the project details, affected DBE subcontractors, and reasons for the requested exemption, with space for additional documentation to support the request.
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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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