Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Print and Mail Election Materials
- Solicitation number
- RFP GGS-26-0079
- 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 Compliance Section for use in conjunction with the Print and Mail Election Materials contract (RFP GGS-26-0079). The form enables prime contractors to request approval for modifications to their Disadvantaged Business Enterprise (DBE) utilization plans, including releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work assigned to DBE subcontractors, or reducing the amount originally proposed for DBE subcontractors. All requests must be submitted to ptdcompliance@phoenix.gov prior to implementing any changes to the proposed statement of DBE utilization. The form requires the prime contractor's authorized representative to document good faith efforts undertaken in attempting to find additional DBE participation and must include supporting documentation justifying the exemption request. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without written approval from the Compliance Section.
The form serves as a critical compliance mechanism for the five-year election materials printing and mailing contract (April 1, 2026 through March 31, 2031, with four potential one-year renewal options) and reflects the City of Phoenix's mandate for significant DBE and small business participation as required by the United States Department of Transportation. Upon approval by the Contract Compliance Specialist, the form documents the revised DBE goal and revised DBE utilization percentage. This administrative process ensures transparency and maintains the integrity of the city's commitment to diverse business participation throughout the contract period, with contractors required to submit an initial DBE/Small Business Participation Plan within 30 days of contract award and maintain monthly documentation of DBE engagement.
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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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