Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Purchase of Motorcycles
- Solicitation number
- 26-FSD-031
- 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) subcontractor participation on public transit contracts. The form serves as the official approval mechanism for prime contractors seeking to release proposed DBE subcontractors, substitute existing DBE subcontractors, modify the scope of work assigned to DBE subcontractors, or reduce the financial amounts originally proposed for DBE participation. Contractors must submit requests to the Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any modifications to their DBE utilization plans or monthly DBE statements. The form requires the prime contractor's authorized representative to certify their authority to request exemptions and to document the good faith efforts undertaken to identify additional DBE participation when seeking approval for reductions or substitutions.
The form includes designated sections for contract compliance use only, where the City's Contract Compliance Specialist reviews and either approves or denies the request, documents the revised DBE goal percentage and revised DBE utilization figures, and references supporting documentation including the Initial SBPP Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment. No DBE subcontractor may be terminated, substituted, or have their scope of work reduced or proposed amount modified without explicit written approval from the Compliance Section, ensuring that the City maintains oversight of all DBE participation commitments throughout the contract period and protects the integrity of small business participation goals.
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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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