Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Part-Time Television Engineering Services
- Solicitation number
- IFB-26-0141
- 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. The form serves as the official mechanism for prime contractors to request approval for modifications to Disadvantaged Business Enterprise (DBE) utilization on contracts with the City of Phoenix. The form addresses the Part-Time Television Engineering Services contract, a five-year agreement commencing on or about May 16, 2026. Prime contractors must submit requests to ptdcompliance@phoenix.gov prior to implementing any changes to their proposed DBE utilization statements or monthly DBE utilization forms. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount modified without explicit approval from the Compliance Section.
The form permits contractors to request exemptions for four categories of modifications: releasing a proposed DBE subcontractor, substituting a DBE subcontractor, changing the scope of work for a DBE subcontractor, or reducing the amount originally proposed for a DBE subcontractor. Contractors must provide detailed documentation of their good faith efforts in identifying additional DBE participation when requesting exemptions. Upon submission, the Contract Compliance Section reviews the request and documents their decision, including any revised DBE goals and utilization percentages. The form requires authorization from a duly authorized representative of the prime contractor and includes sections for the compliance specialist to certify approval status and reference supporting exhibits such as the Initial SBPP Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment.
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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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