Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Evaporative Cooler Maintenance and Repair
- Solicitation number
- IFB-27-FMD-0415
- 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 its Disadvantaged Business Enterprise - Neutral (DBE-N) Program. The form is used to request approval for modifications to small business (SB) subcontractor commitments on City of Phoenix contracts. Prime contractors must submit this form to the City's Compliance Section prior to making any changes to their proposed Statement of Small Business Utilization or Monthly Statement of Small Business Utilization. The form permits requests for four types of exemptions: releasing a proposed SB subcontractor, substituting an SB subcontractor, changing the scope of work performed by an SB subcontractor, or reducing the originally proposed amount for an SB subcontractor. Contractors must provide detailed justification and documentation of good faith efforts in finding additional small business participation when requesting exemptions.
The related contract opportunity is for Evaporative Cooler Maintenance and Repair services with the City of Phoenix, with a commencement date on or about January 18, 2027. The contract term is three years from the commencement date, with two optional one-year extension periods exercisable at the City's sole discretion. All offers must be submitted electronically through the City's Procurement Portal. The form itself does not contain pricing information, set-asides, or funding amounts; those details would be contained in the associated solicitation documents available through the procurement portal.
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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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