Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
PDF 114 KB Posted
- Attached to
- Vactor Services - Requirements Contract
- Solicitation number
- IFB-27-0462
- 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 (PTD) for the Disadvantaged Business Enterprise - Neutral (DBE-N) Program, applicable to the Vactor Services Requirements Contract. The form must be submitted to the City of Phoenix Public Transit Department Compliance Section for approval prior to implementing any changes to the proposed Statement of Small Business (SB) Utilization or the Contractor's Monthly Statement of Small Business Utilization Form. The underlying vactor services contract is a five-year requirements agreement with an effective date upon final signature and recording by the City Clerk's department and a commencement date upon City Council approval or the Effective Date, whichever is later. The contract term is five years beginning on the Commencement Date with no options to extend, and will terminate upon the earliest occurrence of reaching the end of the term or upon termination pursuant to the Agreement's provisions.
The Request for Substitution or Exemption form allows prime contractors to request exemptions to release a proposed SB subcontractor, substitute an SB subcontractor, change the scope of work performed by an SB subcontractor, or reduce the amount originally proposed for an SB subcontractor. All requests must be accompanied by documentation of good faith efforts in finding additional Small Business participation. No small business subcontractor may be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without prior written approval from the Contract Compliance Section. The form requires authorization by a duly authorized representative of the prime contractor and must include a revised small business commitment amount upon approval by the Contract Compliance Specialist.
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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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