Attachment_-_Request_for_Substitution_-_Exemption.pdf
PDF 102 KB Posted
- Attached to
- Fixed Wing Pilot Training PP24-284
- Solicitation number
- RFQu-26-0124
- 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) contracts. The form is designed to obtain formal approval from the City's Compliance Section prior to making any modifications to DBE utilization plans. Prime contractors are required to submit this form to ptdcompliance@phoenix.gov when seeking to release a proposed DBE subcontractor, substitute an existing DBE subcontractor, change the scope of work assigned to a DBE subcontractor, or reduce the amount originally proposed for DBE participation. The document requires detailed documentation of good faith efforts undertaken to secure alternative DBE participation and must be authorized by a duly authorized representative of the prime contractor before submission.
The form specifies that no DBE subcontractor may be substituted, terminated, or have their scope of work reduced or proposed amount modified without prior written approval from the Compliance Section. The document includes designated sections for the prime contractor to justify the requested exemption, provide supporting documentation, and obtain authorization signatures. Upon receipt, the Contract Compliance Section reviews the request and indicates approval status, revised DBE goals and utilization percentages, and the assigned compliance specialist responsible for oversight. This administrative process ensures contract compliance and maintains the integrity of DBE participation goals established for City of Phoenix procurement initiatives.
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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: |
File details come from the government source that posted it. Updated .