Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Lower-Level Displays
- Solicitation number
- IFB-PCC-26-0084
- 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, used to manage Disadvantaged Business Enterprise (DBE) participation changes on public contracts. The form permits prime contractors to request approval from the Compliance Section prior to making modifications to their proposed DBE utilization, including releasing proposed DBE subcontractors, substituting DBE subcontractors, changing the scope of work performed by DBE subcontractors, or reducing amounts originally proposed for DBE subcontractors. All requests require submission to ptdcompliance@phoenix.gov and must include documentation of good faith efforts undertaken to secure additional DBE participation. The form requires authorization by a duly authorized representative of the prime contractor and includes sections for detailing the affected DBE subcontractor(s), the scope of work involved, and supporting documentation justifying the exemption request.
The form is designed to ensure compliance with federal regulations under 49 CFR Part 26 and the City of Phoenix's Small Business Participation Plan requirements. All substitutions, terminations, or modifications to DBE involvement require prior written approval from the Compliance Section; no changes may be implemented without this authorization. The form includes a compliance review section completed by a Contract Compliance Specialist, documenting approval status, revised DBE goals, and revised DBE utilization percentages. This administrative process is integral to the City's oversight of DBE participation on contracts such as the Lower-Level LED display project at the Phoenix Convention Center, which requires contractors to maintain monthly documentation of DBE expenditures and submit annual updated participation plans demonstrating continued good faith efforts toward minority and small business utilization.
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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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