Attachment_-_Request_for_Substitution_-_Exemption.pdf

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Attached to
Plastic Signage Material
Solicitation number
RFQ-26-0143
Issued by
Maricopa County, Arizona

About this file

This is a Request for Substitution/Exemption form issued by the City of Phoenix Public Transit Department for use in managing Disadvantaged Business Enterprise (DBE) participation on public transit contracts. The form enables prime contractors to request approval from the City's Compliance Section prior to making modifications to proposed DBE utilization. Contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work performed by DBE subcontractors, or reduce the amount originally proposed for DBE subcontractors. All requests must be submitted to ptdcompliance@phoenix.gov and include documentation of good faith efforts undertaken to secure additional DBE participation. The form requires authorization from a duly authorized representative of the prime contractor and detailed justification for the requested exemption.

The form serves as the official mechanism for the City of Phoenix to maintain compliance with DBE utilization goals and contract requirements. No DBE subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without prior written approval from the Compliance Section. Upon review, the City's Contract Compliance Specialist documents the decision, indicating whether the request is approved and noting any revised DBE goals and utilization percentages. The form references supporting documentation requirements including the Initial SBPP Plan, DBE Annual SBPP Plan, and DBE Certification of Final Payment exhibits, ensuring comprehensive tracking and accountability of minority business participation throughout contract execution.

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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:

File details come from the government source that posted it. Updated .