Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Solicitation number
- AVN IFB-26-0125
- 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 conjunction with Disadvantaged Business Enterprise (DBE) utilization requirements on public contracts. The form must be submitted to the Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes to proposed DBE utilization or monthly DBE statements. Prime contractors may request exemptions to release proposed DBE subcontractors, substitute DBE subcontractors, change the scope of work performed by DBE subcontractors, or reduce amounts originally proposed for DBE subcontractors. The form requires the authorized representative of the prime contractor to certify their authority, identify the affected DBE subcontractor(s), describe the scope of work involved, and document good faith efforts undertaken to secure additional DBE participation.
The form includes sections for the prime contractor to provide detailed justification for the requested exemption, with space for supporting documentation to be attached as necessary. Upon submission, the Contract Compliance Section reviews the request and provides approval status, revised DBE goals, revised DBE utilization percentages, and identifies the assigned Contract Compliance Specialist. The form also references supporting exhibits including the Initial SBPP Plan, DBE Annual SBPP Plan, DBE Request for Substitution or Exemption documentation, and DBE Certification of Final Payment. No DBE subcontractor may be substituted, terminated, or have their scope of work reduced or proposed amount modified without explicit written approval from the Compliance Section.
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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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