Request_for_Substitution_or_Exemption_PTD_02_2026_(DBE-N).pdf
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- Attached to
- Flow Meters and Level Meters Supplemental
- Solicitation number
- IFB-27-0472
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Request for Substitution or Exemption form (DBE-N) related to the City of Phoenix's Flow Meters and Level Meters Supplemental contract opportunity. The form pertains to Disadvantaged Business Enterprise (DBE) provisions for the five-year supply agreement commencing on or about January 1, 2026. The contract has a fixed term of five years from the Commencement Date with no options to extend and will terminate upon reaching the end of the term or pursuant to agreement provisions, whichever occurs first.
The form serves as a mechanism for offerors to request substitution or exemption from DBE requirements or commitments under this solicitation. As a request form rather than a pricing or technical specification document, it does not contain specific pricing terms, incumbent information, or detailed funding requirements. The document functions as an administrative tool within the City of Phoenix's procurement process to address potential DBE-related modifications to participation requirements for the supplemental flow meters and level meters contract.
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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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