Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Bypass Spools and Tailpieces
- Solicitation number
- IFB-26-0112
- 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 in connection with Disadvantaged Business Enterprise (DBE) utilization requirements on public contracts. The form serves as the official mechanism for prime contractors to request approval for modifications to their DBE participation commitments, including the release or substitution of proposed DBE subcontractors, changes to the scope of work assigned to DBE firms, or reductions to amounts originally allocated to DBE subcontractors. All requests must be submitted to the Public Transit Department Compliance Section prior to implementing any changes and must be accompanied by documentation of good faith efforts to secure alternative DBE participation. The form requires certification by an authorized representative of the prime contractor and includes specific fields for contract identification, affected DBE subcontractor information, and a detailed summary of the exemption request and good faith efforts undertaken.
The form is designed for administrative processing by the Contract Compliance Section, which reviews requests and determines approval status, revised DBE goals, and revised DBE utilization percentages. Notably, this form is referenced as an exhibit requirement in the City of Phoenix Water Services Department's procurement for stainless steel bypass spools, tailpieces, and ductile iron flanged fittings (IFB-26-0112), a five-year contract commencing January 1, 2026. That procurement includes mandatory DBE participation requirements, with contractors required to submit a Small Business Participation Plan within 30 days of award and maintain ongoing monthly reporting of DBE participation through the City's Certification and Compliance System. The substitution/exemption form is thus a critical compliance tool for managing DBE commitments throughout the contract execution period.
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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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