Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Production Well Emergency Support
- Solicitation number
- IFB-27-0486
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution or Exemption form for the Disadvantaged Business Enterprise-Neutral (DBE-N) Program administered by the City of Phoenix Public Transit Department in connection with the Production Well Emergency Support contract. The form must be submitted to the City of Phoenix Public Transit Department Compliance Section prior to making any changes to the proposed Statement of Small Business (SB) Utilization or the Contractor's Monthly Statement of Small Business Utilization Form. The document establishes that no small business subcontractor shall be substituted, terminated, have their scope of work reduced, or have their proposed amount changed without explicit approval from the Contract Compliance Section. Prime contractors may 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.
The form requires the prime contractor's authorized representative to provide detailed justification for any requested exemption, including documentation of good faith efforts undertaken to secure additional small business participation. All requests must include the prime contractor name, contract number, project number and description, affected small business subcontractor information, and the scope of work being modified. The Contract Compliance Section retains authority to approve or deny exemption requests and will document the revised small business commitment amount upon approval. This requirement applies to the five-year Production Well Emergency Support Agreement for the City of Phoenix, effective upon final signature and recording by the City Clerk's department.
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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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