Attachment_-_Request_for_Substitution_-_Exemption.pdf
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- Attached to
- Cancer Screening Services State and local contract opportunity
- Solicitation number
- RFP PS-26-0132
- 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 transit contracts. The form serves as the official mechanism for prime contractors to request approval for changes to their proposed DBE participation, including the release of proposed DBE subcontractors, substitution of DBE subcontractors, modification of scope of work assigned to DBE subcontractors, or reduction of amounts originally proposed for DBE subcontractors. All requests must be submitted to the City of Phoenix Public Transit Department Compliance Section at ptdcompliance@phoenix.gov prior to implementing any changes. The form requires the prime contractor's authorized representative to certify their authority to submit the request and to document the good faith efforts undertaken to secure additional DBE participation when seeking exemptions or substitutions.
The form includes provisions for the prime contractor to detail the affected DBE subcontractor(s), the scope of work to be performed, and a comprehensive summary of the exemption request and associated good faith efforts. Upon receipt, the Contract Compliance Section reviews the submission and provides approval or denial decisions, documenting the revised DBE goal and revised DBE utilization percentage if approved. The form explicitly prohibits any substitution, termination, scope reduction, or amount modification of DBE participation without prior written approval from the Compliance Section, ensuring oversight and enforcement of DBE commitments made during the bidding process.
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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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