Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Chiller and Boiler System Maintenance
- Solicitation number
- IFB FY27-086-03
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution or Exemption form issued by the City of Phoenix Public Transit Department for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program related to solicitation 02_26-IFR. The form applies to a Chiller and Boiler System Maintenance contract, which is a five-year agreement with no options to extend. The contract will commence upon City Council approval or the ordinance-approved start date, whichever is later, and will terminate upon the earliest occurrence of reaching the end of the five-year term or termination under the agreement's provisions. Sealed offers for this maintenance service are being accepted through the City's Procurement Portal.
The form serves as the required submission mechanism for prime contractors seeking approval to make changes to their Small Business (SB) utilization commitments, including releasing a proposed SB subcontractor, substituting an SB subcontractor, reducing an SB subcontractor's scope of work, or modifying the originally proposed amount. No substitutions, terminations, scope reductions, or amount changes are permitted without prior written approval from the Contract Compliance Section. Prime contractors must document good faith efforts in finding additional Small Business participation and provide supporting documentation with their exemption requests. The Contract Compliance Specialist reviews and approves requests, noting any revised Small Business utilization commitments on the form.
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Text version
Disadvantaged Business Enterprise - Neutral (DBE-N) Program AGENCY: Public Transit Department
02_26-IFR - PTD
REQUEST FOR SUBSTITUTION/EXEMPTION
THIS FORM MUST BE SUBMITTED TO THE CITY OF PHOENIX, PUBLIC TRANSIT DEPARTMENT COMPLIANCE SECTION, FOR APPROVAL PRIOR TO MAKING ANY CHANGES TO THE PROPOSED STATEMENT OF SMALL BUSINESS (SB) UTILIZATION OR CONTRACTOR’S MONTHLY STATEMENT OF SMALL BUSINESS UTILIZATION FORM. NO SMALL BUSINESS SHALL BE SUBSTITUTED OR TERMINATED, NOR SHALL THEIR SCOPE OF WORK
BE REDUCED OR PROPOSED AMOUNT CHANGED WITHOUT THE APPROVAL OF THE CONTRACT
COMPLIANCE SECTION.
Prime Contractor: Contract Number:
Project Number and Description:
Affected Small Business Subcontractor(s):
Scope of Work to be Performed by Affected Small Business 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 (circle those that apply);
A. Release a proposed SB subcontractor C. Substitute a SB subcontractor B. Change the scope of work to be performed by an SB subcontractor D. Reduce the amount originally proposed for a
SB subcontractor
3. I have summarized the Prime Contractor's request for an exemption and the good faith efforts required in finding additional Small Business participation on the above-mentioned contract as follows: (Attach additional pages and supporting documentation as necessary.)
Authorized Signature: ________________________________________________ Date: ___________________ Prime Contractor's Representative
Name and Title: _____________________________________________________ Phone: __________________
FOR CONTRACT COMPLIANCE USE ONLY
Request Approved: YES NO Revised Small Business Commitment: $
REVISED SMALL BUSINESS UTILIZATION
Contract Compliance Specialist: Date:
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