Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Chlorine and PH Analyzers
- Solicitation number
- IFB-26-0142
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form used by the City of Phoenix Public Transit Department to manage changes to Disadvantaged Business Enterprise (DBE) utilization commitments on public transit contracts. The form serves as the formal mechanism for prime contractors to request approval for modifications to their proposed DBE participation, including releasing proposed DBE subcontractors, substituting existing DBE subcontractors, changing the scope of work assigned to DBE subcontractors, or reducing the dollar amount originally proposed for DBE participation. Contractors must submit the completed form to the City's Public Transit Department Compliance Section (ptdcompliance@phoenix.gov) prior to implementing any changes, with detailed documentation of good faith efforts undertaken to locate alternative DBE participation. The form requires authorization by a duly authorized representative of the prime contractor and includes fields for contract number, project description, affected DBE subcontractor identification, and scope of work details.
Upon receipt, the City's Contract Compliance Section reviews the request and determines approval status, documenting the revised DBE goal and utilization percentage if modifications are granted. The form establishes a formal compliance checkpoint ensuring that any reduction in DBE participation is supported by documented good faith efforts and represents a substantive exemption process rather than a discretionary change. This procedural requirement underscores the City of Phoenix's commitment to enforcing DBE participation goals on publicly funded transit projects and maintaining accountability in subcontracting relationships throughout the contract term.
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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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