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 from the City of Phoenix Public Transit Department, designed to document changes to Disadvantaged Business Enterprise (DBE) utilization on public transit 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 amounts 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 modifications. The form requires the prime contractor's authorized representative to certify their authority, identify the affected DBE subcontractor(s), detail the scope of work involved, and document good faith efforts made to secure additional DBE participation when applicable. The City's Contract Compliance Section reviews submissions and approves or denies requests, with final determinations documented on the form including any revised DBE goals and utilization percentages.
The form establishes mandatory compliance procedures for DBE participation on City of Phoenix public transit projects, ensuring that any changes to subcontractor arrangements or work scope receive prior written approval from the Compliance Section. No DBE subcontractor may be terminated, substituted, or have their scope reduced or proposed amount changed without explicit authorization. The form functions as a control mechanism to maintain DBE participation commitments established during contract bidding and to document contractor efforts to mitigate impacts of requested substitutions through identification of alternative DBE firms capable of performing required work.
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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 .