Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Rotork Actuators
- Solicitation number
- IFB-26-0140
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution/Exemption form from the City of Phoenix Public Transit Department used to manage Disadvantaged Business Enterprise (DBE) participation modifications on contracts. The form permits prime contractors to request approval for 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 the City of Phoenix Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes to the proposed statement of DBE utilization or the contractor's monthly statement of DBE utilization form. The form requires the duly authorized representative of the prime contractor to provide detailed information regarding the affected DBE subcontractor(s), the scope of work performed, and a comprehensive summary of good faith efforts undertaken to secure additional DBE participation.
The form mandates that no DBE shall be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without explicit approval from the Compliance Section. Upon submission, the Contract Compliance Specialist reviews the request and determines approval status, records any revised DBE goals and utilization percentages, and maintains exhibits documenting the Initial SBPP Plan, DBE Annual SBPP Plan, Request for Substitution or Exemption, and DBE Certification of Final Payment. This form is essential to ensuring DBE program compliance and maintaining the City's commitment to minority business participation on public transit contracts.
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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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