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 issued by the City of Phoenix Public Transit Department for managing Disadvantaged Business Enterprise (DBE) subcontractor changes on public transit contracts. The form allows prime contractors to request approval for modifications to their proposed DBE utilization, including the release of proposed DBE subcontractors, substitution of DBE subcontractors, changes to the scope of work performed by DBE subcontractors, or reductions in the originally proposed amounts for DBE participation. All requests must be submitted to the City's Compliance Section prior to implementation and require documentation of good faith efforts to maintain or replace DBE participation. The form requires the duly authorized representative of the prime contractor to provide detailed information about the affected DBE subcontractor(s), the scope of work involved, and justification for the requested exemption or substitution, with approval authority retained by the Contract Compliance Specialist.
The form functions as an internal compliance and documentation tool rather than a pricing or contracting document. Upon approval by the Compliance Section, the form captures the revised DBE goal and utilization percentages for the contract record. This form is specifically applicable to the City of Phoenix's Rotork Actuators procurement (IFB-26-0140), which includes robust DBE and Small Business Participation Plan requirements under 49 CFR Part 26. Contractors on this five-year contract must track all DBE and small business engagement through the City's Certification and Compliance System and demonstrate continued good faith efforts throughout contract performance.
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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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