Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Lutron Lighting Systems
- Solicitation number
- IFB PCC-26-0101
- 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 use by prime contractors seeking approval to modify Disadvantaged Business Enterprise (DBE) subcontractor participation on state and local contracts. The form must be submitted to the City of Phoenix Public Transit Department Compliance Section (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. Prime contractors are authorized to request exemptions or substitutions for DBE subcontractors, including the release of proposed DBE subcontractors, substitution of DBE subcontractors, changes to the scope of work performed by DBE subcontractors, or reduction of amounts originally proposed for DBE subcontractors. The form requires the duly authorized representative of the prime contractor to provide a summary of the exemption request and documentation of good faith efforts made to secure additional DBE participation. All approvals must be granted by the City's Contract Compliance Section before any modifications to DBE utilization can be executed, with the compliance specialist completing a separate section confirming approval status and revised DBE goals and utilization percentages.
No specific pricing terms, funding amounts, or contract values are detailed within this form document. The form serves as an administrative mechanism for managing DBE participation requirements under the City of Phoenix's Small Business Participation Plan (SBPP), requiring contractors to demonstrate compliance with DBE utilization goals established for individual contracts. Contractors must maintain current DBE certifications and cannot unilaterally modify subcontractor arrangements without prior written approval from the City's Compliance Section, ensuring accountability in the City's commitment to promoting disadvantaged business participation in public procurement opportunities.
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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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