Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Cartographic Services
- Solicitation number
- PKS-RFP-27-0470
- 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. The form establishes the procedural requirements for prime contractors to request approval from the City's Contract Compliance Section prior to making any modifications to their proposed Statement of Small Business (SB) Utilization or monthly reporting. The document permits contractors to request exemptions to release a proposed small business subcontractor, substitute an existing small business subcontractor, change the scope of work assigned to a small business subcontractor, or reduce the amount originally proposed for a small business subcontractor. All requests require detailed justification demonstrating good faith efforts to maintain or secure small business participation and must include supporting documentation as necessary.
The form requires authorization from a duly authorized representative of the prime contractor and mandates that no small business subcontractor shall be substituted, terminated, or have their scope of work reduced or proposed amount modified without explicit approval from the Contract Compliance Section. Upon review, the compliance specialist documents the approval decision, effective date, and revised small business commitment dollar amount. This form applies to the Cartographic Services contract opportunity for the City of Phoenix, which has an effective date upon final signature and recording by the City Clerk's Department, a commencement date of February 1, 2027, a term of two years with one optional three-year extension exercisable at the City's sole discretion, and will terminate upon the earliest occurrence of contract expiration or termination per agreement provisions.
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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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