Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- IFB-26-0107
- 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 managing Disadvantaged Business Enterprise (DBE) participation on contracts. The form allows prime contractors to request approval for changes to their DBE utilization, including releasing or substituting DBE subcontractors, modifying scope of work, or adjusting proposed amounts for DBE participation. Contractors must submit requests to the City of Phoenix Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any changes to their proposed DBE utilization statement or monthly DBE reporting. The form requires the authorized representative of the prime contractor to provide a summary of the exemption request and document good faith efforts made to secure additional DBE participation on the affected contract, with supporting documentation attached as necessary. The form includes fields for contract number, project description, affected DBE subcontractor information, and scope of work details, along with date and signature requirements from both the contractor and the City's Contract Compliance Specialist.
The form serves as a compliance control mechanism for the City of Phoenix's DBE program requirements, which mandate tracking and reporting of minority and disadvantaged business participation throughout contract execution. The Compliance Section retains authority to approve or deny substitution and exemption requests and must document any approved changes to the original DBE goal and revised DBE utilization percentage. This form is required for all contracts subject to the City's Small Business Participation Plan and DBE provisions, ensuring that contractors maintain commitment to utilizing certified disadvantaged businesses and document any deviations from their original participation commitments with supporting justification.
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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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